Does male sexual abstinence reduce the risk of prostate cancer?

Male Sexual Abstinence and Prostate Cancer Risk

There is no clear evidence that male sexual abstinence reduces the risk of prostate cancer; in fact, some evidence suggests that frequent ejaculation may be protective against prostate cancer development.

Relationship Between Sexual Activity and Prostate Cancer Risk

Current evidence indicates that sexual activity may actually have a protective effect against prostate cancer through several mechanisms:

• Frequent ejaculation appears to be protective against prostate cancer development 1
• Multiple sexual partners may potentially reduce prostate cancer risk (though this must be balanced against the risk of sexually transmitted infections) 1

The protective effect of ejaculation may be related to:

• Clearing of potential carcinogens from the prostate gland
• Reducing inflammation or prostatic congestion
• Hormonal effects related to ejaculation

Sexual Function and Prostate Cancer Treatment

While abstinence doesn't appear to reduce prostate cancer risk, it's important to understand how prostate cancer treatment affects sexual function:

• All prostate cancer treatments can affect erectile function 2
• Men on androgen deprivation therapy (ADT) experience the worst rates of sexual dysfunction 3
• Even after 3-4 months of ADT, men's sexual desire decreases and irreversible damage may occur to erectile tissue 3
• Approximately 50% of men experience permanent erectile dysfunction even after discontinuing ADT 3

Considerations for Prostate Cancer Prevention

Rather than sexual abstinence, other approaches have shown more promise for prostate cancer risk reduction:

1. 5-alpha-reductase inhibitors (5-ARIs): These medications have been shown to reduce prostate cancer incidence, though with important considerations:

   • 5-ARIs can reduce prostate cancer incidence by about 15 cases per 1,000 men over 7 years 2
   • However, there may be a small increased risk of high-grade cancer (about 3 cases per 1,000 men) 2
   • Sexual side effects include decreased libido, which is reversible upon discontinuation 2

2. Exercise: Recent evidence suggests exercise may have benefits for prostate health and sexual function:

   • Supervised resistance and aerobic exercise improved erectile function in men with prostate cancer 4
   • Exercise also improved body composition and physical function 4

Clinical Implications and Recommendations

For men concerned about prostate cancer risk:

1. Do not recommend sexual abstinence as a preventive measure for prostate cancer
2. Consider discussing frequent ejaculation as a potentially protective factor, though more research is needed
3. For men at higher risk of prostate cancer, discuss appropriate screening options following current guidelines:
   • Men between 50-69 years should be informed about the limited benefits and substantial harms of prostate cancer screening 2
   • High-risk men (African American race, family history) should receive information about screening beginning at age 45 2
   • Men with multiple family members diagnosed with prostate cancer before age 65 should receive information beginning at age 40 2

Common Pitfalls to Avoid

• Assuming abstinence is protective: The evidence suggests the opposite may be true
• Overemphasizing sexual activity as a preventive measure: While frequent ejaculation may be protective, it's just one of many factors affecting prostate cancer risk
• Neglecting to discuss overall prostate health: Regular check-ups, healthy lifestyle, and appropriate screening based on risk factors remain important

In summary, men should be reassured that sexual activity is not a risk factor for prostate cancer, and in fact, regular ejaculation may provide some protective benefit.