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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Article Info
Publication History
Published online: March 28, 2016
Accepted:
March 16,
2016
Associate Editor: Matthew CooperbergIdentification
Copyright
© 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reply to Cédric Annweiler, Pierre Bigot, and Spyridon N. Karras’ Letter to the Editor re: Jennifer R. Rider, Kathryn M. Wilson, Jennifer A. Sinnott, Rachel S. Kelly, Lorelei A. Muccia, Edward L. Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol 2016;70:974–82European UrologyVol. 71Issue 1
- PreviewAnnweiler et al suggest an interesting alternative mechanism that could link higher ejaculation frequency to lower overall prostate cancer risk as reported in our study [1] using data from the Health Professionals Follow-up Study (HPFS). As indicated by the authors, accumulating data suggest that vitamin D may be involved in prostate cancer development and progression. Annweiler et al offer evidence from animal studies and dialysis patients that vitamin D also contributes to sexual function, which is perhaps less widely appreciated.
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- Reply to Herney Andrés García-Perdomo and Ramiro Manzano Nunez's Letter to the Editor Re: Jennifer R. Rider, Kathryn M. Wilson, Jennifer M. Sinnott, Rachel S. Kelly, Lorelei A. Mucci, Edward L. Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol 2016;70:974–82: Looking Deeper: P-hacking and Some Other BiasEuropean UrologyVol. 70Issue 6
- PreviewWe are grateful for the opportunity to respond to comments regarding our recently published study [1]. Drs. García-Perdomo and Manzano Nunez raise the potential for p-hacking in light of the substantial number of statistical tests performed. To avoid fishing for significant p values, our a priori approach involved a hypothesis about directionality of the association, a clearly defined primary analysis, and the use of p values for trend to determine statistical significance. These p values for trend were highly significant and statistically significant at the 0.05 α level, even after correction for multiple comparisons using a conservative Bonferroni approach [2].
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- Re: Jennifer R. Rider, Kathryn M. Wilson, Jennifer M. Sinnott, Rachel S. Kelly, Lorelei A. Mucci, Edward L. Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol 2016;70:974–82: Looking Deeper: P-hacking and Some Other BiasEuropean UrologyVol. 70Issue 6
- Re: Jennifer R. Rider, Kathryn M. Wilson, Jennifer A. Sinnott, Rachel S. Kelly, Lorelei A. Muccia, Edward L. Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol 2016;70:974–82European UrologyVol. 71Issue 1
- PreviewIn a recent issue of European Urology, Rider and colleagues [1] reported the results of an interesting US-based prospective cohort study of 31 925 men, testing the association between ejaculation frequency throughout adulthood and incidence of prostate cancer (PCa). The authors found that the risk of PCa was approximately 20% lower among those with ≥21 ejaculations per month compared to those with 4–7 ejaculations per month [1]. The main explanation provided by the authors was based on the avoidance of prostatic accumulation of potentially carcinogenic secretions, also called prostate stagnation hypothesis [1].
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