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Platinum Priority – Prostate Cancer Editorial by Sarah K. Holt, George R. Schade and John L. Gore on pp. 983–984 of this issue| Volume 70, ISSUE 6, P974-982, December 01, 2016

Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up

  • Author Footnotes
    1 These authors contributed equally to this work.
    Jennifer R. Rider
    Correspondence
    Corresponding author. Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA. Tel. +1 617 6385035; Fax: +1 617 5667805.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Kathryn M. Wilson
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • Jennifer A. Sinnott
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Rachel S. Kelly
    Affiliations
    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • Lorelei A. Mucci
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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  • Edward L. Giovannucci
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA

    Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Background

      Evidence suggests that ejaculation frequency may be inversely related to the risk of prostate cancer (PCa), a disease for which few modifiable risk factors have been identified.

      Objective

      To incorporate an additional 10 yr of follow-up into an original analysis and to comprehensively evaluate the association between ejaculation frequency and PCa, accounting for screening, clinically relevant disease subgroups, and the impact of mortality from other causes.

      Design, setting, and participants

      A prospective cohort study of participants in the Health Professionals Follow-up Study utilizing self-reported data on average monthly ejaculation frequency. The study includes 31 925 men who answered questions on ejaculation frequency on a 1992 questionnaire and followed through to 2010. The average monthly ejaculation frequency was assessed at three time points: age 20–29 yr, age 40–49 yr, and the year before questionnaire distribution.

      Outcome measurements and statistical analysis

      Incidence of total PCa and clinically relevant disease subgroups. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

      Results and limitations

      During 480 831 person-years, 3839 men were diagnosed with PCa. Ejaculation frequency at age 40–49 yr was positively associated with age-standardized body mass index, physical activity, divorce, history of sexually transmitted infections, and consumption of total calories and alcohol. Prostate-specific antigen (PSA) test utilization by 2008, number of PSA tests, and frequency of prostate biopsy were similar across frequency categories. In multivariable analyses, the hazard ratio for PCa incidence for ≥21 compared to 4–7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72–0.92; p < 0.0001 for trend) for frequency at age 20–29 yr and 0.78 (95% CI 0.69–0.89; p < 0.0001 for trend) for frequency at age 40–49 yr. Associations were driven by low-risk disease, were similar when restricted to a PSA-screened cohort, and were unlikely to be explained by competing causes of death.

      Conclusions

      These findings provide additional evidence of a beneficial role of more frequent ejaculation throughout adult life in the etiology of PCa, particularly for low-risk disease.

      Patient summary

      We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer.

      Keywords

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