Is regular ejaculation beneficial for prostate health in middle-aged men?

Regular Ejaculation and Prostate Health in Middle-Aged Men

Regular ejaculation appears protective against prostate cancer in middle-aged men, with the strongest evidence showing that men who ejaculate 21 or more times per month have approximately 20-30% lower risk of prostate cancer compared to those ejaculating 4-7 times monthly. 1

Evidence for Protective Effect

The most robust data comes from the Health Professionals Follow-up Study, which tracked 31,925 men over 18 years and found:

• Men reporting ≥21 ejaculations per month at ages 40-49 years had a 22% reduced risk of prostate cancer (HR 0.78,95% CI 0.69-0.89) compared to those with 4-7 ejaculations monthly 1
• The protective effect was consistent across the lifespan, with similar benefits observed for ejaculation frequency at ages 20-29 years (HR 0.81) 1
• The association was strongest for low-risk disease and remained significant even after accounting for PSA screening patterns 1

A more recent case-control study (CAPLIFE, 2023) corroborated these findings from a different angle:

• Men with 0-3 ejaculations per month had 2.38 times higher odds of prostate cancer (aOR 2.38,95% CI 1.57-3.60) compared to those with >4 ejaculations monthly 2
• The association was even stronger for aggressive disease (ISUP grade 3-5): aOR 2.76 for men with 0-3 ejaculations/month 2
• Men with locally advanced or metastatic tumors showed the highest risk with low ejaculation frequency (aOR 4.70) 2

Biological Mechanisms

The protective mechanism appears to involve gene expression changes in normal prostate tissue:

• 409 genes and six biological pathways were differentially expressed in normal prostate tissue according to ejaculation frequency 3
• These molecular alterations occur in adjacent normal tissue rather than tumor tissue, suggesting ejaculation influences early carcinogenic processes 3
• The proposed mechanisms include clearance of potentially carcinogenic secretions and reduction of intraprostatic inflammation 4, 5

Clinical Implications

For middle-aged men (ages 40-60), regular ejaculation of at least 21 times per month appears to confer meaningful prostate cancer risk reduction without known harms. 1

Practical Considerations:

• The protective effect applies to all forms of ejaculation: sexual intercourse, masturbation, and nocturnal emissions 4
• The benefit is most pronounced for clinically significant, organ-confined disease rather than indolent cancers 1
• No increased risk was observed at any ejaculation frequency, including very high frequencies 4, 1

Important Caveats:

• This recommendation applies to prostate cancer risk reduction only and should not influence decisions about PSA screening, which remains controversial 6
• For PSA testing purposes, men should abstain from ejaculation for 48 hours before testing to avoid falsely elevated results 6
• The evidence does not suggest ejaculation frequency affects outcomes in men already diagnosed with prostate cancer 6

Quality of Life Considerations

Beyond cancer risk, ejaculatory function is a key component of sexual health and quality of life:

• Erectile dysfunction should be treated first in men with both ED and ejaculatory concerns, as ED treatment often resolves secondary ejaculatory problems 6, 7
• Regular sexual activity, including ejaculation, is associated with maintained sexual function in aging men 6
• Patient and partner satisfaction should be the primary outcome measure for any sexual health intervention 6

The evidence strongly supports that regular ejaculation (≥21 times monthly) throughout adulthood, particularly during middle age, is associated with reduced prostate cancer risk, especially for clinically significant disease, without identified harms. 1, 2