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

By: Jennifer R. Ridera b 1 âŽ Kathryn M. Wilsona c 1Jennifer A. Sinnotta dRachel S. KellycLorelei A. Muccia c and Edward L. Giovannuccia
European Urology, Volume 70 Issue 6, December 2016, Pages 974-982
Published online: 01 December 2016

Abstract Full Text Full Text PDF (354 KB)


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.


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.


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.

Take Home Message

In a large prospective study with long-term follow-up, men who reported more frequent ejaculation in adulthood had a lower risk of total incidence of prostate cancer. Ejaculation frequency represents a potentially modifiable risk factor for prostate cancer.

Keywords: Epidemiology, Ejaculation, Behavioral risk factors.


a Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

b Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

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

d Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

e Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

⁎ 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. 

1 These authors contributed equally to this work. 


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