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Ejaculation Frequency and Subsequent Risk of Prostate Cancer
Abstract
Sexual activity has been hypothesized to play a role in the development of prostate cancer, but epidemiological data are virtually limited to case-control studies, which may be prone to bias because recall among individuals with prostate cancer could be distorted as a consequence of prostate malignancy or ongoing therapy.
To examine the association between ejaculation frequency, which includes sexual intercourse, nocturnal emission, and masturbation and risk of prostate cancer.
Prospective study using follow-up data from the Health Professionals Follow-up Study (February 1, 1992, through January 31, 2000) of 29 342 US men aged 46 to 81 years, who provided information on history of ejaculation frequency on a self-administered questionnaire in 1992 and responded to follow-up questionnaires every 2 years to 2000. Ejaculation frequency was assessed by asking participants to report the average number of ejaculations they had per month during the ages of 20 to 29 years, 40 to 49 years, and during the past year (1991).
Incidence of total prostate cancer.
During 222 426 person-years of follow-up, there were 1449 new cases of total prostate cancer, 953 organ-confined cases, and 147 advanced cases of prostate cancer. Most categories of ejaculation frequency were unrelated to risk of prostate cancer. However, high ejaculation frequency was related to decreased risk of total prostate cancer. The multivariate relative risks for men reporting 21 or more ejaculations per month compared with men reporting 4 to 7 ejaculations per month at ages 20 to 29 years were 0.89 (95% confidence interval [CI], 0.73-1.10); ages 40 to 49 years, 0.68 (95% CI, 0.53-0.86); previous year, 0.49 (95% CI, 0.27-0.88); and averaged across a lifetime, 0.67 (95% CI, 0.51-0.89). Similar associations were observed for organ-confined prostate cancer. Ejaculation frequency was not statistically significantly associated with risk of advanced prostate cancer.
Our results suggest that ejaculation frequency is not related to increased risk of prostate cancer.
... Hence, sexual behavior may be another of the habits related to PCa. The number of sexual partners, age at first intercourse [8,9], and ejaculation frequency (EF) have been some of the main characteristics studied in relation to PCa [9][10][11][12], yielding contradictory results. While two cohort studies propose the existence of a possible inverse association between EF and PCa risk [11,12], a case-control study proposes a possible risk association with the number of orgasms [9]. ...
... The number of sexual partners, age at first intercourse [8,9], and ejaculation frequency (EF) have been some of the main characteristics studied in relation to PCa [9][10][11][12], yielding contradictory results. While two cohort studies propose the existence of a possible inverse association between EF and PCa risk [11,12], a case-control study proposes a possible risk association with the number of orgasms [9]. In this sense, a 2019 systematic review of the European Association of Urology Section of Oncological Urology (ESOU) concluded that wellconducted longitudinal studies are required to assess whether suggested associations between sexual behavior, including EF, and PCa are "real or spurious" [13]. ...
... To our knowledge, no study has evaluated the association between EF and PCa based on urinary symptoms at the moment of the diagnosis. Furthermore, regarding tumor aggressiveness and stage of PCa, few studies have considered it, and their results do not point in the same direction [10][11][12]. ...
Purpose:
To evaluate the association between ejaculation frequency (EF) during four stages of life and prostate cancer (PCa) according to tumor aggressiveness, PCa stage, and urinary symptomatology.
Materials and methods:
A total of 456 incident PCa cases histologically confirmed, and 427 controls aged 40-80 years from the CAPLIFE study were analyzed. This study is a population-based case-control study carried out in the south of Spain. Average EF was measured for: (1) 20s, (2) 30s, (3) 40s, and (4) one year before the interview. EF was categorized into: (1) 0-3, (2) 4, and (3) >4 ejaculations/month. Sociodemographic, lifestyle, and medical information were also collected. To estimate the association between EF and PCa, adjusted ORs (aORs) and 95% CIs were calculated by logistic regression models.
Results:
A year before the interview, PCa cases ejaculated less frequently than the controls. An inverse association was observed between the EF a year before and PCa, aOR=1.64 (95% CI 1.03-2.61) for men with 4 ejaculations/month, and aOR=2.38 (95% CI 1.57-3.60) for men with 0-3 ejaculations/month, compared to men with >4. The association was higher for cases with ISUP 3-5 (aOR=2.76 [95% CI 1.34-5.67] for men with 0-3 ejaculations/month) or with a locally advanced-metastatic tumor (aOR=4.70 [95% CI 1.55-14.29]). Moreover, men with moderate urinary symptoms and 0-3 ejaculations/month had the highest risk, aOR=3.83 (95% CI 1.84-7.95).
Conclusions:
A low EF could be associated with a higher risk of PCa, especially for cases with ISUP 3-5 or with a locally advanced-metastatic tumor.
... Finally, this systematic review only included 2 studies. 12,13 The studies screened of this process was shown in Figure 1. Characteristics of patient were summarized in Table 1. ...
... (0.73,1.10), ages 20 to 29 years; multivariate RR, 95%CI, 0.68, (0.53,0.86), ages 40 to 49 years; multivariate RR, 95%CI, 0.49 (0.27, 0.88), previous year; multivariate RR, 95%CI, 0.67 (0.51, 0.89), averaged across a lifetime] compared with men reporting 4 to 7 ejaculations per month. 12 Rider et al., 13 showed that there were 3839 men diagnosed with PCa during 480831 person-years. PCa was less frequently diagnosed among men who had the higher ejaculation frequency (21 or more ejaculations per month, multivariable HR, 95% CI, 0.81, (0.72, 0.92), P<0.0001 for trend, ages 20 to 29 years; multivariable HR, 95% CI, 0.78, (0.69, 0.89), P<0.0001 for trend, ages 40 to 49 years] compared with men reporting 4 to 7 ejaculations per month. ...
... PCa was less frequently diagnosed among men who had the higher ejaculation frequency (21 or more ejaculations per month, multivariable HR, 95% CI, 0.81, (0.72, 0.92), P<0.0001 for trend, ages 20 to 29 years; multivariable HR, 95% CI, 0.78, (0.69, 0.89), P<0.0001 for trend, ages 40 to 49 years] compared with men reporting 4 to 7 ejaculations per month. 13 The two trials 12,13 indicated that higher ejaculation frequency is associated with reducing risk of PCa. However, lower ejaculation frequency is not associated with reducing risk of PCa. ...
... Other studies have shown that low levels of vitamin D will increase the possibility of prostate cancer [10]. Recent studies have shown that ejaculation frequency is not related to increased risk of prostate cancer [11]. This same study found that high ejaculation frequency was related to decreased risk of total prostate cancer [11]. ...
... Recent studies have shown that ejaculation frequency is not related to increased risk of prostate cancer [11]. This same study found that high ejaculation frequency was related to decreased risk of total prostate cancer [11]. The histopathologic diagnosis connected to prostate cancer diagnosis allows for a sub-diagnosis of prostate cancer in addition to discernment if a cancer is present [12]. ...
Cancer of the prostate are cancers in which most incidences are slow growing and in the U.S., a record of 1.2 million new cases of prostate cancer occurred in 2018. The rates of this type of cancer have been increasing in the developing nations. The risk factors for prostate cancer include age, family history, and obesity. It is believed that the rate of prostate cancer is correlated with the Western diet. Various advances in methods of radiotherapy have contributed to lowering morbidity. Therapy for hormone-refractory prostate cancer is making progress, for almost all men with metastases will proceed to hormone-refractory prostate cancer. Smoking cigarettes along with the presence of prostate cancer has been shown to cause a higher risk of dying from prostate cancer. The serious outcome of incontinence and erectile dysfunction result from the cancer treatment of surgery and radiation, particularly for prostate-specific antigen detected cancers that will not cause morbidity or mortality. Families of patients, as well as patients, are profoundly affected following the diagnosis of prostate cancer. Poor communication between spouses during prostate cancer increases the risk for poor adjustment to prostate cancer. The use of serum prostate-specific antigen to screen for prostate cancer has led to a greater detection, in its early stage, of this cancer. Prostate cancer is the most common malignancy in American men, accounting for more than 29% of all diagnosed cancers and about 13% of all cancer deaths. A shortened course of hormonal therapy with docetaxel following radical prostatectomy (or radiation therapy) for high-risk prostate cancer has been shown to be both safe and feasible. Patients treated with docetaxel-estramustine had a prostate-specific antigen response decline of at least 50%. Cancer vaccines are an immune-based cancer treatment that may provide the promise of a non-toxic but efficacious therapeutic alternative for cancer patients. Further studies will elucidate improved methods of detection and treatment.
... In 2004, the Health Professionals Follow-Up Study (HPFS) cohort reported a significant positive relation between monthly ejaculation frequency and prostate cancer risk based on 8 years of follow-up [330]. ...
... The ejaculatory frequency may influence prostate cancer development through several mechanisms. One biological mechanism is described as "prostate stagnation hypothesis", which involves the prostatic accumulation of potentially carcinogenic secretions that may create a favorable environment for prostate cancer development [330,333]. More frequent ejaculation may alter the function of peripheral-zone epithelial cells, which start to oxidate citrate rather than secrete it. ...
Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide. Prostate cancer may be asymptomatic at the early stage and often has an indolent course that may require only active surveillance. Based on GLOBOCAN 2018 estimates, 1,276,106 new cases of prostate cancer were reported worldwide in 2018, with higher prevalence in the developed countries. Differences in the incidence rates worldwide reflect differences in the use of diagnostic testing. Prostate cancer incidence and mortality rates are strongly related to the age with the highest incidence being seen in elderly men (> 65 years of age). African-American men have the highest incidence rates and more aggressive type of prostate cancer compared to White men. There is no evidence yet on how to prevent prostate cancer; however, it is possible to lower the risk by limiting high-fat foods, increasing the intake of vegetables and fruits and performing more exercise. Screening is highly recommended at age 45 for men with familial history and African-American men. Up-to-date statistics on prostate cancer occurrence and outcomes along with a better understanding of the etiology and causative risk factors are essential for the primary prevention of this disease.
... The numbers reported fell into 5 possible ranges (none, 1-3, 4-7, 8-12, and ≥13 per month). 12 In China, a median and mean sexual frequency of 4 times each month was reported by the general population at reproductive age, 13 , 14 according to which 4 ejaculations were selected as a cut-off. For patients with CP/CPPS, 8 ejaculations per month were regarded as excessive in literature and thus served as another cut-off point. ...
Background:
Acupuncture can improve chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Ejaculation frequencies might impact the conditions of CP/CPPS. The present study aimed to explore the impact of different ejaculation frequencies on the effect of acupuncture among men with CP/CPPS.
Methods:
This was a secondary analysis of the data from a multicenter, randomized, clinical trial. Eligible participants were patients with moderate to severe CP/CPPS, who had taken 8-week acupuncture treatment, and followed until week 32. Participants fell into the category of 0-3, 4-7, or at least 8 according to their monthly ejaculation frequencies reported at baseline. The primary outcome was the proportion of responders, defined as men who reported at least 6 points reduction from baseline in the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) total score at weeks 8 and 32.
Results:
214 participants were included in this secondary analysis, of whom 42 reported a monthly ejaculation frequency of 0-3, 89 reported a frequency of 4-7, and 83 reported a frequency of at least 8. At week 8, 52.20% participants with an ejaculation frequency of 0-3 responded to the acupuncture treatment, 65.38% participants with a frequency of 4-7 responded, and 63.09% participants with a frequency of at least 8 responded. At week 32, 56.14%, 59.57%, and 68.36% participants responded in the three groups, respectively. No significant differences were observed between three groups (all P>0.05).
Conclusion:
Acupuncture can improve symptoms of CP/CPPS, regardless of ejaculation frequencies. Ejaculation frequencies may not affect the efficacy of acupuncture on CP/CPPS among Chinese men.
Trial registration:
ClinicalTrials.gov, NCT03213938.
... Men with a high frequency of ejaculation are thought to wish to preserve sexual function, thus reducing PSA screening. 57 These factors may have contributed to selection bias in the included non-ED population and thus influenced the PSA analysis results. Thus, differences in PSA levels in populations with and without SD may have resulted from a combination of factors, and elevated PSA levels may not be a major cause of the high risk of prostate cancer in individuals with SD. ...
Background
Whether there is a connection between sexual dysfunction (SD) and prostate cancer (PCa) is controversial.
Aim
We sought to review the interrelationship between SD and PCa and to determine whether there is a definitive risk of men developing PCa after suffering from SD.
Methods
A complete search of the PubMed, Web of Science, Ovid MEDLINE, Embase, and Cochrane Library databases was performed to search for eligible studies published up to October 2022. The protocol for this meta-analysis is available from PROSPERO (ID: CRD42022342381).
Outcomes
The associations between SD and the risk of PCa were assessed by calculating pooled ORs with 95% CIs, and the standard mean difference (SMD) and its 95% CI were used to assess the relationship between SD and prostate-specific antigen (PSA) levels or prostate volume (PV). Random-effects models were used to account for potential heterogeneity, and the Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of the included studies.
Results
Twenty studies involving 215,626 individuals were included in our meta-analysis. Compared with controls, subjects with SD had a 1.62-fold increased risk of PCa (OR = 1.62, 95% CI, 1.77-2.23, P = .003; heterogeneity: I2 = 97.8%, P < .001). Patients with SD had higher PSA levels than controls (SMD =0.07, 95% CI, 0.00 to 0.13, P = .041; heterogeneity: I2 = 55.6%, P = .027). However, there was no association between SD and PV (SMD = 0.03, 95% CI, −0.05 to 0.11, P = .122; heterogeneity: I2 = 48.5%, P = .100).
Clinical Implications
Current evidence confirms a potential link between SD and the risk of PCa and that SD in PCa patients should be of concern to clinicians.
Strengths and Limitations
The strength of this study is that it is to our knowledge the first meta-analysis of studies on the risk of PCa in men with SD. A limitation is that most of the studies included in this meta-analysis focused on ED.
Conclusion
Our systematic review and meta-analysis results suggest that men with SD have a higher risk of PCa and higher PSA levels than men without SD. However, this is merely inferential, and causality cannot be determined based on the current data. Further longitudinal studies should be performed to validate our preliminary findings.
... Sex, albeit crucial for species survival and evolution, goes beyond reproduction: recreative and pleasurable sex is observed across taxa (Balcombe, 2009;Georgiadis, Kringelbach and Pfaus, 2012;Zer-Krispil et al., 2018) and plays a pivotal role in the establishment of social bonds (Cappelleri et al., 2007). In humans, sex can have additional effects on well-being, such as improvement of cognition (Maunder, Schoemaker and Pruessner, 2017) or prevention of disease (Leitzmann et al., 2004). Moreover, sexual dysfunction can lead to great distress in individuals and their sexual partners (Carson and Gunn, 2006). ...
During sex, male arousal increases up to the ejaculatory threshold, allowing genital sensory input to trigger ejaculation. While copulation and arousal increase are thought to be centrally regulated, ejaculation is a reflex controlled by a spinal circuit, whose activity is strongly inhibited by descending input from the brain, bearing no role on the regulation of sexual behavior up until the arousal threshold. However, this hypothesis remains untested. To tackle this problem, we combined genetic approaches with electrophysiological and behavioral analysis to functionally map the spinal circuit controlling the main muscle involved in sperm expulsion, the bulbospongiosus muscle (BSM). We found that BSM motor neurons (BSM-MNs) receive direct synaptic input from a group of galanin-expressing (Gal+) interneurons located in the upper lumbar spinal cord. Furthermore, the Gal+ population is progressively activated during sexual behavior and receives genital sensory input. Electrical and optogenetic activation of the Gal+ neurons evoked activity in BSM-MNs and BSM after spinalization. Interestingly, these effects were dependent on the behavioral state of the male and drastically decreased with repeated stimulation. Moreover, genetic ablation of the Gal+ neurons severely impacted the latency to ejaculate and the structure of the copulatory sequence. Taken together, our results imply an unexpected involvement of the spinal cord in the control of copulatory behavior, sexual arousal and in the post-ejaculatory refractory period, in addition to its well established role in ejaculation.
... Since increased cell turnover can influence the initiation of benign or malignant hyperplasia, sexual frequency may have an impact on the development of the prostate-related diseases. The correlation has been interrogated by some association studies using human subjects, but the conclusions were contradictory (Fernandez et al., 2005;Jacobsen et al., 2003;Leitzmann et al., 2004;Oishi et al., 1990;Rider et al., 2016) due to various confounding factors (Annweiler et al., 2017;Garcia-Perdomo and Manzano Nunez, 2016). Therefore, mouse models may be used in the future to determine the impact of physiology-or pathobiology-associated changes in mechanical signaling on the initiation and progression of benign and malignant diseases in the prostate. ...
Functional implication of stromal heterogeneity in the prostate remains incompletely understood. Using lineage tracing and light-sheet imaging, we show that some fibroblast cells at the mouse proximal prostatic ducts and prostatic urethra highly express Lgr5. Genetic ablation of these anatomically restricted stromal cells, but not nonselective ablation of prostatic stromal cells, rapidly induces prostate epithelial turnover and dedifferentiation that are reversed following spontaneous restoration of the Lgr5⁺ stromal cells. RNA sequencing (RNA-seq) analysis indicates that ablating the Lgr5⁺ stromal cells activates a mechanosensory response. Ablating the Lgr5⁺ stromal cells impairs the control of prostatic ductal outlet, increases prostate tissue stiffness, and activates the mitogen-activated protein kinase (MAPK). Suppressing MAPK overrides the elevated epithelial proliferation. In summary, the Lgr5⁺ stromal cells regulate prostate tissue homeostasis and maintain its functional integrity in a long-distance manner. Our study implies that the cells at organ junctions most likely control organ homeostasis by sustaining a balanced mechanoforce.
... Finally, it is proven to healthily safeguard the spouses from getting diseases like cancer. For instance, "when married man often sexes and have three ejaculations per week, he will by 15% reduce the risk of obtaining prostate cancer in life (Leitzmann, 2004). ...
This study sought to find how married couples perceived marital sex, using the survey Research Design. A total of 200 respondents came from selected marriages found in Kihesa Ward. Such number was obtained through the purposive sampling technique which was followed by effective distribution of questionnaires in gathering the information which was analyzed using frequencies and percentages. The study established that married couples perceived marital sex as a practice that binds them together emotionally and psychologically. It alienates prostate cancer, irregular menstrual cycles and cardiovascular diseases; it naturally communicates affection and love to the spouses, especially when done into satisfaction. It is helpful in the continuation of spouses' generation after fusion of gametes, fertilization and conception have taken place. Moreover, married couples agreed that they enjoy doing sex with their spouses. Marital sex should take place in a form of penile-Vaginal penetration, because it is proven to be the most satisfying one as designed by the creator of humanity.
... Masturbation is also promoted as a safesex behavior (Robinson et al., 2002;Coleman, 2003) to prevent the transmission of diseases. Some empirical studies found that masturbation reduces the risk of prostate cancer (Leitzmann et al., 2004;Aboul-Enein et al., 2016;Rider et al., 2016), although not completely conclusive [e.g., see Dimitropoulou et al. (2009)]. For the causal understanding of the potential relation between masturbation and prostate cancer risk, experimental, and longitudinal studies are needed. ...
Despite its relevance for human sexuality, literature on potential effects of ejaculation frequency and masturbation on general and mental health outcomes is sparse. Reasons for this knowledge gap include a general lack of interest, but also methodological challenges and still existing superstition. This paper reconciles literature from various fields to extract relevant information on how ejaculation frequency effects general and mental health outcomes. Culture-bound syndromes have been reported in countries still strictly tabooing or condemning masturbation. Masturbatory guilt describes a phenomenon in individuals experiencing a discrepancy between moral standards and own behavior with respect to masturbation. Abstinence is one aspect under study in the area of fertility treatment. Specific time frames and their respective implications on quality of sperm remain inconclusive. Limited temporal resolution capacities hamper the precise study of brain structures directly activated during ejaculation. The relation between ejaculation frequency and hormonal influences remains poorly understood. Future research that specifically addresses ejaculation frequency and potential mental and general health outcomes is needed. In contrast to extracting knowledge as a byproduct from other studies with a different focus, this enables sound study designs and could provide evidence-based results which could then be further discussed and interpreted.
... Exposure to various environmental factors can cause chronic inflammation in the prostate and stimulate cancer development and progression. The presence of pathogens in the urogenital organ and gut [152,153] as well as sexual activity [154,155] are associated with chronic inflammation and prostate cancer ( Figure 2). The DNA adduct of PhIP, a type of DNA damage, was identified in prostate cancer tissues of patients who frequently consumed cooked red meat [156]. ...
Chronic inflammation is a major cause of human cancers. The environmental factors, such as microbiome, dietary components, and obesity, provoke chronic inflammation in the prostate, which promotes cancer development and progression. Crosstalk between immune cells and cancer cells enhances the secretion of intercellular signaling molecules, such as cytokines and chemokines, thereby orchestrating the generation of inflammatory microenvironment. Tumor-associated macrophages (TAMs) and myeloid-derived suppressor cells (MDSCs) play pivotal roles in inflammation-associated cancer by inhibiting effective anti-tumor immunity. Anti-inflammatory agents, such as aspirin, metformin, and statins, have potential application in chemoprevention of prostate cancer. Furthermore, pro-inflammatory immunity-targeted therapies may provide novel strategies to treat patients with cancer. Thus, anti-inflammatory agents are expected to suppress the “vicious cycle” created by immune and cancer cells and inhibit cancer progression. This review has explored the immune cells that facilitate prostate cancer development and progression, with particular focus on the application of anti-inflammatory agents for both chemoprevention and therapeutic approach in prostate cancer.
... Individuals may be empowered to come to terms with their developing sexuality, which may be particularly beneficial for youth struggling with their sexual orientation. Healthy sexual attitudes and behaviors may promote improved health-both physically and psychologically-because they are linked to lower stress levels (Burleson, Trevathan, & Todd, 2007;Hamilton, Rellini, & Meston, 2008;Lee, Macbeth, Pagani, & Young, 2009); reduced blood pressure (Grewen & Light, 2011;Svetkey et al., 2005); improved cognitive functioning (Ahlskog, Geda, Graff-Radford, & Peterson, 2011;Hartmans, (Segerstrom & Miller, 2004); and reduction of risk for certain types of cancers, such as prostate cancer (Hyde et al., 2010;Leitzmann, Platz, Stampfer, Willett, & Giovannucci, 2004); self-esteem is increased (Diamond, 2003;Onder et al., 2003); and interpersonal relationships are strengthened (Tessler & Gavrilova, 2010). ...
Differentiating Theists and Nontheists by way of a Sampling of Self-Reported Sexual Thoughts and Behaviors
... Individuals may be empowered to come to terms with their developing sexuality, which may be particularly beneficial for youth struggling with their sexual orientation. Healthy sexual attitudes and behaviors may promote improved health-both physically and psychologically-because they are linked to lower stress levels (Burleson, Trevathan, & Todd, 2007;Hamilton, Rellini, & Meston, 2008;Lee, Macbeth, Pagani, & Young, 2009); reduced blood pressure (Grewen & Light, 2011;Svetkey et al., 2005); improved cognitive functioning (Ahlskog, Geda, Graff-Radford, & Peterson, 2011;Hartmans, (Segerstrom & Miller, 2004); and reduction of risk for certain types of cancers, such as prostate cancer (Hyde et al., 2010;Leitzmann, Platz, Stampfer, Willett, & Giovannucci, 2004); self-esteem is increased (Diamond, 2003;Onder et al., 2003); and interpersonal relationships are strengthened (Tessler & Gavrilova, 2010). ...
Differentiating Theists and Nontheists by way of a Sampling of Self-Reported Sexual Thoughts and Behaviors
... Similarly, there was a retrospective study of 4974 men with ED from 50 to 69 years old without history of prostate cancer, of which men being treated with PDE5I over 7 years were observed to have lower incidence rate of the prostate cancer (PDE5I users: 4.1%; non-PDE5I users: 9.9%) and lower PSA level [23]. As expected, increased ejaculation frequency of PDE5I users was a potential protective effect on prostate cancer [24,25]. ...
Purpose
Conduct a systematic review and meta-analysis of studies to evaluate the association between the use of PDE5I and biochemical recurrence (BCR) after radical prostatectomy (RP).
Methods
We searched Embase (from 1996 to Feb 2018), PubMed (from 1996 to Feb 2018), and Cochrane library (from 1999 to Feb 2018), then manually searched the reference lists of key retrieved articles. Original studies that reported the risk of postoperative BCR for PDE5I users, as compared with non-PDE5I users, were included. Data including the characteristic of participants, the risk of BCR after RP and key criteria of study quality were collected. The pooled relative risks (RRs) were calculated with random-effects model.
Results
A total of 5 cohort studies and 1 case–control study were conducted for data analysis (a total of 17752 participants). Only 1 cohort study reported adjusted RR greater than 1 (range for all derived RRs, 0.7–1.47). The meta-analysis revealed that the PDE5I users had no higher risk of BCR after RP (RR = 1.04, 95% confidence interval [CI], 0.79–1.36). Sensitivity analysis showed that the remaining pooled RR and 95% CI were not changed significantly by omitting each study. In addition, the 5-year BCR rate had no significant difference between PDE5I users and non-PDE5I users.
Conclusions
Our meta-analysis indicated that PDE5I treatment in men following RP did not increase the risk of BCR. The results preliminarily suggested that the use of PDE5I for erectile dysfunction after RP was oncologically safe. Nevertheless, more large sample cohort studies are needed to validate this conclusion.
... Indeed, while in the absence of androgens oxytocin had no effect on prostate cancer cell lines (LNCaP and PC-3), in the presence of testosterone low oxytocin doses stimulated proliferation of PC-3 cells [81] , supporting the notion that changes in levels of oxytocin in the prostate in aging and cancer may promote prostate epithelial cell proliferation. It is possible that increased levels of oxytocin might be involved in the mechanisms by which high ejaculation frequency is related to decreased risk of prostate cancer [82] . This hypothesis needs to be further investigated. ...
The neuropeptide hormone oxytocin, which is released from the posterior pituitary gland, is involved in a number of physiological processes. Understanding of its effects is gradually increasing due to new research in this area. While mostly recognized as a reproductive system hormone, oxytocin also regulates other organ systems such as the brain and cardiovascular system. Recently, research has focused on unraveling its involvement in cancer, and emerging evidence suggests a potential role for oxytocin as a cancer biomarker. This review summarizes observations linking oxytocin and cancer, with a special emphasis on prostate cancer, where it may promote cell proliferation. Research suggests that oxytocin effects may depend on cell type, concentration of the hormone, its interactions with other hormones in the microenvironment, and the precise localization of its receptor on the cell membrane. Future research is needed to further elucidate the involvement of oxytocin in cancer, and whether it could be a clinical cancer biomarker or therapeutic target.
... These include frequent urination, nocturia, difficulty starting and maintaining a steady stream of urine, hematuria, and dysuria. [8] About a third of patients diagnosed with prostate cancer have one or more such symptoms, while two thirds have no symptoms. [9] The primary risk factors are obesity, age and family history. ...
... -in other words, a 33% reduced risk. Other than for this high frequency category of ejaculation, the authors concluded, "Our results suggest that ejaculation frequency is not related to increased risk of prostate cancer" [ 68 ]. However, a more recent study showed that men who engaged in frequent masturbation, of about two to seven times a week, during their 20s and 30s, had a higher rate of prostate cancer, while men who engaged in masturbation once a week during their 50s had a lower rate [ 69 ]. ...
A guide for men about what they should be aware of before deciding to have a test for prostate cancer. Open access full text (pdf0 available here https://open.sydneyuniversitypress.com.au/9781920899684.html
... Ågmo, 2008;Beach, 1956) or the cause of disease (e.g. Leitzmann, Platz, Stampfer, Willett, & Giovannucci, 2004) nor does it appear to lead to "sublimation" in the shape of increased creativity (Kinsey et al., 1948). Moreover, a lack of partner sex does not increase masturbation frequency (Laumann, 1994) or nocturnal orgasms (Kinsey et al., 1953). ...
Sexual offending behavior is a complex and multifaceted phenomenon. Most existing etiological models describe sexual offending behavior as a variant of offending behavior and mostly include factors referring to disinhibition and sexual deviance. In this article, we argue that there is additional value in describing sexual offending behavior as sexual behavior in terms of an incentive model of sexual motivation. The model describes sexual arousal as an emotion, triggered by a competent stimulus signaling potential reward, and comparable to other emotions coupled with strong bodily reactions. Consequently, we describe sexual offending behavior in terms of this new model with emphasis on the development of deviant sexual interests and preferences. Summarized, the model states that because sexual arousal itself is an emotion, there is a bidirectional relationship between sexual self-regulation and emotional self-regulation. Not only can sex be used to regulate emotional states (i.e., sexual coping), emotions can also be used, consciously or automatically, to regulate sexual arousal (i.e., sexual deviance). Preliminary support for the model is drawn from studies in the field of sex offender research as well as sexology and motivation research.
... thus, longer intervals between ejaculations provide greater opportunity for tumorigenesis [2,3]. We hypothesized that if this were true, gene expression patterns in the prostate tissue may vary according to EF. We, therefore, analyzed the expression of 20 254 genes in the prostate tumor (and adjacent normal) tissue of 157 (85) men with prostate cancer from the HPFS. ...
In a prospective study of 31 925 men with 18 yr of follow-up, higher ejaculation frequency (EF) throughout adulthood was associated with lower rates of prostate cancer. To further explore this association, we evaluated whole transcriptome gene expression in the prostate tissue from study participants who developed prostate cancer between 1992 and 2004 (n=157 tumor tissue, n=85 adjacent normal). We tested for trends in gene expression according to the level of EF as self-reported in 1992 for ages 20-29 yr, 40-49 yr, and the year prior to the questionnaire, 1991. There were no associations between EF and gene expression in areas of tumor after accounting for multiple testing. In contrast, in the adjacent normal tissue, 409 genes and six pathways were differentially expressed at a false discovery rate ≤0.2 across categories of EF in 1991. These results suggest that ejaculation affects the expression of genes in the normal prostate tissue. The identified genes and pathways provide potential biological links between EF and prostate tumorigenesis.
Patient summary:
To explore previous findings that men who ejaculate more frequently have lower risk of prostate cancer, we evaluated molecular alterations in the prostate tissue according to each man's frequency of ejaculation prior to diagnosis. We identified biological processes that could link ejaculation frequency and prostate cancer.
... There are studies showing that age of initial sexual activity and frequency of ejaculation are effective in development of PCa. The increase in frequency of ejaculation reduces the carcinogenic material concentration within prostatic fluids and intraluminal prostatic crystalloid accumulation and thus it is reported that frequency of ejaculation may be protective against cancer (14)(15)(16). In our study, we identified that both groups were similar in terms of the markers of ejaculation frequency of first masturbation age, first sexual debut age and frequency of sexual relations when young and currently. ...
Aim:
Although prostate cancer (PCa) is the most common cancer type in men, a replaceable risk factor has not yet been established. In our study, we assessed the relationship between the number of sexual partners, age of first sexual experience and age of first masturbation and prostate cancer incidence.
Materials and methods:
In Ordu University Department of Urology between January 2013 and September 2016, in PSA elevation and rectal examination, patients with prostate biopsy were evaluated due to nodule palpation in the prostate. At younger ages and at present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded. The correlation between the obtained data and PCa frequency was evaluated.
Results:
The study included 146 patients with PCa identified on biopsy and 171 patients with benign biopsy results who answered the questions. 66.7% of the ones whose biopsy results were benign and 40.6% of cancer suspects had only one sexual partner. The median number of sexual partners was 1±4 (1-100) in the benign group and 2±6 (1-500) in the malignant group (p=0.039). There was a negative correlation between age of first sexual debut and number of partners (r: -0,479; p<0.001).
Conclusion:
In our study, it appears that there may be an association between the number of sexual partners and prostate cancer in the patient group with PSA level above 4ng/mL. Avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer.
... Nevertheless, the same complaint could be directed towards research studies which offer opposite results. An earlier study claims that there is no connection between ejaculation and increased risk of prostate cancer also acknowledges the methodological failures and necessity for additional interpretation: "… there are several plausible alternative explanations for our results" (Leitzmann et al, 2004(Leitzmann et al, : 1583. ...
Educational policy in Croatia is facing serious problems due to disagreement on introduction of sex education in the national curriculum. This article combines two perspectives in defining the theoretically and practically relevant issues of implementing the sex education curriculum. From the ‘top down perspective’ it observes stakeholders’ arguments which are not in accordance on ‘what to do’ (they are not in ‘practical accordance’). Later on, from the ‘bottom up perspective’, the author observes how practical value judgments depend on silent (unspoken) theoretical (concepts of knowledge and of what it means to be human) and practical premises (derived from normative sources). This article defines the frame of the open question of contemporary philosophy on logical procedures of fair and rational resolution of different viewpoints. When faced with practical disagreement, the author argues that the communication ethics of argumentation should consist of discussion topics on theoretical premises: can question postulates of the opposing side – their truthfulness, sincerity and desirability. While exploring differences in attitudes, this article by default analyzes tacit premises of those who implement the compulsory national curriculum on sex education. The basic assumption for problem resolution related to implementation of the sex education curriculum is in reaching an understanding about theoretical premises, and not in proving one’s own attitudes and ideas of how to actualize the plan. Understanding theoretical premises provides a way to establish common ground as a basis and starting point for discussion. Although existing solutions indicate general possibility for compulsory national sex education curriculum in multicultural democracy, in this case common ground is not reached.
... In addition to the possible anti-neoplastic effects of PDE5i treatment, there is some evidence to suggest that increased ejaculatory frequency could be protective with regard to prostate cancer. In their 2004 manuscript, Leitzmann et al. describe a possibly protective effect of increased ejaculatory frequency, with a lifetime relative risk of 0.67 (95% CI: 0.51-0.89) in men who ejaculated four to seven times per month (7). Therefore, since ED patients treated with PDE5i would be expected to ejaculate more frequently than those without, this seemed to provide further evidence as to a link between PDE5i use and prostate cancer. ...
Background
To treat erectile dysfunction (ED), phosphodiesterase type 5 inhibitors (PDE5i) are commonly used. However, to date, only a few studies exist evaluate a possible effect on the incidence of prostate cancer. One such study completed by the authors’ institution suggested men who use PDE5i for ED may have a lower incidence of prostate cancer. This study was meant to address some of the shortcomings of the former study and further characterize the link between prostate cancer and PDE5i use.
Methods
A retrospective, match-paired analysis was undertaken: 5,717 patients were identified between 2000 and 2011; a 1:2 match pair analysis ultimately identified 394 cases with cancer and 788 controls without cancer. Pairs were matched based on age, ethnicity, and PSA value.
Results
No correlation existed between PDE5i use and prostate cancer [OR 1.02, 95% confidence interval (CI): 0.78–1.35, P=0.8842] or diabetes mellitus and prostate cancer (OR 1.12, 95% CI: 0.84–1.48, P=0.4499). A statistically significant correlation was demonstrated with PSA and prostate cancer (OR 1.48, 95% CI: 1.38–1.58, P<0.0001).
Conclusions
The data suggest that there is essentially no association with PDE5i use and prostate cancer.
... This can be explained by the fact that, the blacks had greater total and transitional zone prostate volume, besides the benign prostatic tissue of black men appears to contribute more prostate-specific antigen(PSA) to the circulating blood than does the benign prostatic tissue of white men (4,29) . In the current study the findings revealed that, men who reported sexual activity at least twice a week or more were less likely to have benign prostatic hyperplasia symptoms, in agreement with other studies (30,31) . In contrast with Jacobsen et al. who found that, no relationship between the frequency of ejaculation and benign prostatic hyperplasia (32) . ...
... However, little empirical support has been produced for this drive model. While thwarted sexual desire may give rise to feelings of frustration, not having sex is not detrimental to physiological functioning (e.g., Ågmo, 2008;Beach, 1956) or the cause of disease (e.g., Leitzmann, Platz, Stampfer, Willett, & Giovannucci, 2004) nor does it appear to lead to "sublimation" in the shape of increased creativity (Kinsey, Pomeroy, & Martin, 1948). Moreover, a lack of partner sex does not increase masturbation frequency (Laumann, 1994) or nocturnal orgasms (Kinsey, Pomeroy, Martin, & Gebhard, 1953). ...
Previous research regarding sexual offending has been focused on the empirical identification of reliable predictors of sexual recidivism. Currently, the field is in need of theoretical frameworks that describe the aetiology of sexual offending behaviour and clarify the nature of sexual deviance and its role in the mechanisms of sexual offending. Contrary to popular belief, sexual offending behaviour does not automatically imply sexual deviance, nor does sexual deviance imply the inevitability of sexual offending behaviour. This chapter applies an Incentive Theory of Sexual Motivation, which describes sexual desire as an emotional response to a competent stimulus, to sexual offending behaviour. The theory was originally developed to describe normal sexual behaviour; however, it also provides a promising starting point for uncovering the mechanisms of sexual offending behaviour and the role of sexual deviance therein.
... Among those that have are older age, smoking, and obesity [7].Further investigation of the risk factors and their associated mechanisms of carcinogenesis is crucial to develop strategies for preventing and treating PCa [8]. Sexual activity is hypothesized as affecting prostate carcinogenesis, though the association between ejaculatory frequency and subsequent risk of PCa is controversial [9,10]. A previous study revealed that compared with men with erectile dysfunction (ED) who were not treated with phosphodiesterase type 5 inhibitors (PDE5i), men with ED who were treated with PDE-5i tended to exhibit a lower likelihood of being diagnosed with PCa because they were expected to exhibit higher ejaculation frequency than those not treated with PDE5i [11]. ...
Background:
Prostate cancer (PCa) is the most commonly diagnosed malignancy and the third leading cause of cancer death among men in developed countries. Because some risk factors are common between erectile dysfunction (ED) and PCa, we investigated the association between ED and subsequent PCa.
Methods:
This nationwide population-based cohort study used data from the Taiwan National Health Insurance Research Database for the period 2000-2010. We identified patients newly diagnosed with ED by using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.
Results:
In total, 5858 and 23432 patients were enrolled in the ED and non-ED cohorts, respectively. After adjustment for age, sex, and comorbidities, the overall incidence densities of PCa were significantly higher in the ED cohort than in the non-ED cohort, with an adjusted hazard ratio (aHR) of 1.19. The age-specific relative risk of PCa was significantly higher for all age groups in the ED cohort than in the non-ED cohort. Compared with patients without ED, those with organic ED had a 1.27-fold higher risk of PCa.
Conclusion:
ED is a harbinger of PCa in some men. Physicians should consider the possibility of occult PCa in patients with ED regardless of age and comorbidities.
... It is important to note that a significant body of data has demonstrated that sex reduces the risk for a number of diseases, including cancer 38,39 . For example in our study, the expression of Wnt3a is significantly elevated (fold change 7.53) at ejaculation (EJ group), and Wnt9b and Cdkn1a are up-regulated at ejaculation that is stimulated by 8-OH-DPAT and inhibited by dapoxetine treatment. ...
The 5-HT1A receptor agonist 8-hydroxy-2-[di-n-propylamino] tetralin (8-OH-DPAT) promotes ejaculation of male rats, whereas dapoxetine delays this process. However, the gene expression profile of the brain at ejaculation following administrationof these two compounds has not been fully elucidated. In the present study, a transcriptomic BodyMap was generated by conducting mRNA-Seq on brain samples of male Sprague–Dawley rats. The study included four groups: pre-copulatory control (CK) group, ejaculation (EJ) group, 0.5mg/kg 8-OH-DPAT-ejaculation group (DPAT), and 60mg/kg dapoxetine-ejaculation (DAP) group. The resulting analysis generated an average of approximately 47 million sequence reads. Significant differences in the gene expression profiles of the aforementioned groups were observed in the EJ (257 genes), DPAT (349 genes) and the DAP (207 genes) compared with the control rats. The results indicate that the expression of Drd1 and Slc6a3 was significantly different after treatment with 8-OH-DPAT, whereas the expression of Drd4 was significantly different after treatment with dapoxetine. Other genes, such as Wnt9b, Cdkn1a and Fosb, exhibited significant differences in expression after the two treatments and are related to bladder cancer, renal cell carcinoma and sexual addiction. The present study reveals the basic pattern of gene expression that was activated at ejaculation in the presence of 8-OH-DPAT or dapoxetine, providing preliminary gene expression information during rat ejaculation.
... 35 36 Similarly, findings on the association between frequency of ejaculation and risk of prostate cancer are conflicting . 37 38 Thus the possible biological relation, if any, between vasectomy and prostate cancer remains unclear. ...
Objective To determine the association between vasectomy and prostate cancer, adjusting for measures of health seeking behaviour.
Design Population based matched cohort study.
Setting Multiple validated healthcare databases in Ontario, Canada, 1994-2012.
Participants 326 607 men aged 20 to 65 who had undergone vasectomy were identified through physician billing codes and matched 1:1 on age (within two years), year of cohort entry, comorbidity score, and geographical region to men who did not undergo a vasectomy.
Main outcomes measures The primary outcome was incident prostate cancer. Secondary outcomes were prostate cancer related grade, stage, and mortality.
Results 3462 incident cases of prostate cancer were identified after a median follow-up of 10.9 years: 1843 (53.2%) in the vasectomy group and 1619 (46.8%) in the non-vasectomy group. In unadjusted analysis, vasectomy was associated with a slightly increased risk of incident prostate cancer (hazard ratio 1.13, 95% confidence interval 1.05 to 1.20). After adjustment for measures of health seeking behaviour, however, no association remained (adjusted hazard ratio 1.02, 95% confidence interval 0.95 to 1.09). Moreover, no association was found between vasectomy and high grade prostate cancer (adjusted odds ratio 1.05, 95% confidence interval 0.67 to 1.66), advanced stage prostate cancer (adjusted odds ratio 1.04, 0.81 to 1.34), or mortality (adjusted hazard ratio 1.06, 0.60 to 1.85).
Conclusion The findings do not support an independent association between vasectomy and prostate cancer.
... 18 Eppure i maschi potrebbero contare su un inedito vantaggio di prevenzione ricorrendo ad un tradizionale passatempo: sembra che, per ridurre effettivamente il rischio di cancro alla prostata nella misura del 33%, sia utile una pratica sessuale che comporti almeno 21 eiaculazioni mensili. 19 A seconda del metodo di eiaculazione utilizzato l'obiettivo preventivo potrà essere più convenientemente raggiunto da coloro con problemi di «ejaculatio praecox» poiché, oltre all'ovvio guadagno di tempo, eviteranno pure la ormai classica prescrizione di dapoxetina (Priligy ® ) che, per un costo unitario di 8-9 euro, ritarda il raggiungimento dell'orgasmo di circa 90 secondi. 20 ...
... These regions comprise components of the mesolimbic of prostate cancer with the number of sexual partners, suggesting that infectious factors did not account for the di erence. A questionnaire study of 50,000 men, aged 40 to 75 years, was con rmatory (Leitzmann et al., 2004). Men who reported at least 21 ejaculations per month (via intercourse or masturbation) had a signi cantly lower risk of prostate cancer than men who reported seven or fewer ejaculations per month. ...
Many vertebrate animals engage in masturbation and it is also prevalent in primates. Given the gregarious nature of this order, this is perhaps surprising, since, by definition, it occurs to the exclusion of others. Our research maps the masturbatory landscape of the primate order, highlighting the distribution and diverse forms self-stimulation of the genitalia takes: from an infant vervet monkey grasping his own penis in his mouth, to female chimpanzees using water spigots to stimulate their clitorises. We also examine the causation of this behavior. While autosexual behavior can be a substitute for allosexual interactions, many acts of masturbation seem to serve functions, which fall broadly under two categories: avoidance of pathogen transmission and reduction of mate competition. In terms of implications for human public health, the finding that masturbation is ubiquitous throughout the primate order, practiced by wild-living members of both sexes and all age-groups is a strong counter-argument to voices who condemn human masturbation as "unnatural."
Masturbation is one of the most common sexual behaviors in humans. It is also a phylogenetically widespread trait of various other mammalian and some non-mammalian species. Several hypotheses have been proposed aiming to explain the function of masturbation in primates and other species. These were mainly based on observations of nonhuman primates such as rhesus macaques or bonobos and rodents such as African ground squirrels. Based on these observations various scholars suggested that masturbation improves ejaculate quality, decreases the risk of contracting sexually transmitted infections or is merely a by-product of sexual arousal and thus an alternate outlet to copulation. While these theories may explain some facets of masturbation in some species, they do not explain why masturbation is so widespread and has developed in various species as well as our hominid ancestors. Moreover, the research on which these theories are based is scarce and heavily focused on male masturbation, while female masturbation remains largely unexplored. This sex difference may be responsible for the one-sided theorizing that attributes a specific biological benefit to masturbation. We propose that the widespread prevalence of masturbation in the animal kingdom may be better explained by viewing masturbation as a primarily self-reinforcing behavior that promotes pleasure both in human and in nonhuman species.
Previous studies found that testosterone was converted to dihydrotestosterone under the catalysis of 5α-reductase in the prostate of the wild ground squirrels. As a result, this study explored further whether testosterone could be converted to estrogen to affect the prostate gland function in wild ground squirrels. Histological observation showed that the area of epithelial cells and the prostatic secretory lumen were enlarged significantly during the breeding period. Transcriptome analysis revealed that the differentially expressed genes in the prostate were concentrated in the estrogen signaling pathway. Immunohistochemical analysis showed that the immunoreactivities of P450arom were detected in the stromal cells during the breeding and non-breeding periods, indicating the possible conversion of androgen into estrogen locally. Moreover, the immunolocalizations of ERα and ERβ were detected mainly in the epithelial or stromal cells. Additionally, qPCR analysis displayed that the mRNA expression level of P450arom in the prostate was significantly higher during the breeding period than that in the non-breeding period. Consistently, the concentration of 17β-estradiol (E2) was higher in the prostate during the breeding period than the non-breeding period, which is positively correlated with the seasonal changes of prostatic weight. In conclusion, the present results indicated that estrogen produced by P450arom presented in stromal cells might regulate the growth and function of the prostate gland via the locally expressed estrogen receptors in wild ground squirrels. The results of this study were momentous for further uncovering the mechanism of the seasonal regulated by signal pathways in the prostate of wild ground squirrels.
Context
Worldwide, prostate cancer (PCa) represents the second most common solid tumor in men.
Objective
To assess the geographical distribution of PCa, epidemiological differences, and the most relevant risk factors for the disease.
Evidence acquisition
Estimated incidence, mortality, and prevalence of PCa for the year 2020 in 185 countries were derived from the IARC GLOBOCAN database. A review of English-language articles published between 2010 and 2020 was conducted using MEDLINE, EMBASE, and Scopus to identify risk factors for PCa.
Evidence synthesis
In the year 2020, there were over 1 414 000 estimated new cases of PCa worldwide, with an age-standardized rate (ASR) incidence of 31 per 100 000 (lifetime cumulative risk: 3.9%). Northern Europe has the highest all-age incidence ASR (83), while the lowest ASR was in South-Central Asia (6.3). In the year 2020, there were over 375 000 estimated deaths worldwide, and the overall mortality ASR was 7.7 per 100 000, with the highest ASR in the Caribbean (28) and the lowest in South-Central Asia (3.1). Family history, hereditary syndromes, and race are the strongest risk factors for PCa. Metabolic syndrome was associated with the risk of developing PCa, high-grade disease, and adverse pathology. Diabetes and exposure to ultraviolet rays were found to be inversely associated to PCa incidence. Cigarette smoking and obesity may increase PCa-specific mortality, while regular physical activity may reduce disease progression. Although 5-alpha reductase inhibitors are known to be associated with a reduced incidence of PCa, available studies failed to show an effect on overall mortality.
Conclusions
Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.
Patient summary
Prostate cancer (PCa) rates vary profoundly worldwide, with incidence and mortality rates being highest in Northern Europe and Caribbean, respectively. South-Central Asia has the lowest epidemiological burden. Family history, race, and hereditary syndromes are well-established risk factors for PCa. Modifiable risk factors may impact the risk of developing PCa and that of dying from the disease itself, but little evidence exist for any clear indication for prevention other than early diagnosis to reduce PCa mortality.
Background:
The etiology of benign prostatic hyperplasia and prostate cancer are unknown, with ageing being the greatness risk factor.
Methods:
This new perspective evaluates the available interdisciplinary evidence regarding prostate ageing in terms of the cell biology of regulation and homeostasis, which could explain the timeline of evolutionary cancer biology as degenerative, inflammatory and neoplasm progressions in these multifactorial and heterogeneous prostatic diseases.
Results:
This prostate ageing degeneration hypothesis encompasses the testosterone-vascular-inflamm-ageing triad, along with the cell biology regulation of amyloidosis and autophagy within an evolutionary tumorigenesis microenvironment.
Conclusions:
An understanding of these biological processes of prostate ageing can provide potential strategies for early prevention and could contribute to maintaining quality of life for the ageing individual along with substantial medical cost savings.
Le cancer est désormais considéré comme une maladie chronique touchant une population toujours croissante. Une prise en charge et un suivi à long terme, à l’origine d’un bouleversement de la vie des patients et de leur entourage, semblent nécessaires et sont susceptibles d’initier une réorganisation du système de santé. Dans ce travail de thèse interdisciplinaire, nous nous sommes intéressés à l’impact du cancer sur le vécu psychologique et psychosocial des patients en France, en choisissant le modèle du cancer de la prostate. Pour cela, nous avons souhaité combiner deux études. L’une portait sur l’état de santé sexuelle des patients atteints d’un cancer de la prostate via une approche quantitative descriptive basée sur les données représentatives des enquêtes nationales VICAN. L’autre visait à déterminer l’impact du cancer de la prostate sur le couple et sa qualité de vie via une approche compréhensive qualitative complémentaire, focalisée sur une prise en charge en Surveillance Active et basée sur des entretiens semi-directifs de patients et de leurs conjointes. L’analyse des données a permis de montrer une détérioration de la santé sexuelle des patients, selon différents déterminants non nécessairement médicaux, et un endommagement du couple et des relations affectives perçues, avec des stratégies d’ajustements divergentes pour chacun des membres du couple, malgré une prise en charge initialement considérée comme optimale et indemne de conséquences. Une approche pluridisciplinaire pourrait permettre un accompagnement complet des couples pour une amélioration de leurs vécus, de leur bien-être et de leur qualité de vie
Prostate cancer (PC a) is the second most common cancer worldwide in males. The incidence increases with age and positive family history. Most cancers are adenocarcinomas (>95%), multifocal and originated in the peripheral zone of prostate. Localized PCa is typically asymptomatic and is discovered through a rise in serum PSA or, less commonly, a suspicious digital rectum examination. Hesitance, urgency, poor urine stream, nocturia and incomplete bladder emptying are the most frequently reported symptoms. Their presence suggests advanced disease. On the other hand, bone pain raises the suspicion of metastatic disease. Transrectal ultrasound guided biopsy is the standard method of diagnosis. Treatment strategy is driven by tumor staging and can include a wide variety of approaches such as active surveillance, surgery, radiotherapy and/or medical therapy. Recently, there was the development of multiple new active treatment modalities, particularly in the setting of advanced disease.
Chronic inflammation resulting from infections, altered metabolism, inflammatory diseases or other environmental factors can be a major contributor to the development of several types of cancer. In fact around 20% of all cancers are linked to some form of inflammation. Evidence gathered from genetic, epidemiological and molecular pathological studies suggest that inflammation plays a crucial role at various stages of prostatic carcinogenesis and tumor progression. These include initiation, promotion, malignant conversion, invasion, and metastasis. Detailed basic and clinical research in these areas, focused towards understanding the etiology of prostatic inflammation, as well as the exact roles that various signaling pathways play in promoting tumor growth, is critical for understanding this complex process. The information gained would be useful in developing novel therapeutic strategies such as molecular targeting of inflammatory mediators and immunotherapy-based approaches.
Even with the well‐recognized benefits of exercise, levels of physical activity are on the decline, while weight gain levels are increasing. The purpose of this evidence‐based literature review was to investigate the relationship between physical fitness, sexual functioning and overall health. There is too little information about these relationships to the detriment of educational programming efforts designed to help protect the public against noncommunicable diseases and their associated individual, family, organization, and societal costs. The literature review revealed that even modest increases in physical activity were positively associated with enhanced sexual functioning. Sexual functioning was also strongly linked to overall health, supporting the usefulness of including sensitively‐presented information about the benefits of exercise and being physically fit as it relates to sexual functioning in adult health education curricula. Gender and age differences, physical self‐concept, and well‐being also emerged as important factors when considering the links between physical fitness, sexual functioning and overall health. Recommendations for research included (a) controlling for possible social desirability effects and (b) designing new research that follows the association between physical activity, sexual functioning and overall health longitudinally in more international settings beyond the U.S. and western Europe.
This chapter provides an overview of Kant’s practical sexual ethic, drawing attention to the way in which his views are informed by both his philosophical anthropology and his understanding of gender. I begin by examining what Kant says about “the character of the sexes,” which is the phrase he uses to describe what we would call “gender.” Specifically, I present the way in which Kant characterizes women and analyze the implications of his account for (a) his understanding of the moral agency of women, and (b) his understanding of gender relations. Next, I examine Kant’s understanding of sexual appetite and explain the ways in which he thinks it involves the objectification of the object of one’s sexual desire. I conclude the chapter with a detailed examination of Kant’s treatment of various sexual vices in order to bring to light the moral reasoning that informs his practical sexual ethic. In this way I hope to identify how and why Kant finds sex problematic, which will allow me in the next chapter to explain why and to what extent he thinks marriage is the solution to this problem.
The male rat has been used extensively as a model for evaluating the neurophysiology of sexual behavior. However, gene expression in the brain throughout the process of sexual intercourse has yet to be elucidated. In the present study, we created a transcriptomic BodyMap by performing mRNA-Seq on brain samples from pre-copulatory control (CK), fourth intromission (CR4), ejaculation (EJ) and post-ejaculatory interval 1-min (PEI1) Sprague Dawley rats (n = 40, all male, each 10). The resulting analysis generated an average of approximately 47 million sequence reads, indicating changes in roughly 21255 genes for each sample. Among of them, significant differences in gene expression relative to control rats were observed in the CR4 (139 genes), EJ (257 genes), and PEI1 (130 genes) groups. KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analysis identified 22 pathway-related genes. We further identified eight important genes related to neural pathways using RT-qPCR and Western blot, ruling out the possibility of false positives. The results of the present study not only revealed the basic pattern of gene expression during male rate sexual activity but also provide preliminary data and methodology for further research regarding animal sexual activity.
Background: There is a growing population of geriatric men experiencing sexual health concerns. These issues may stem from surgical interventions of the prostate gland, age-related changes affecting erectile dysfunction, or other concerns. Objectives: To illuminate the male sexual dysfunctions lessened via pelvic floor muscle rehabilitation and proper education to assist clinicians in achieving positive patient outcomes. Methods: The literature was reviewed from 1996 to 2015 using PubMed. Results: Effective conservative care strategies exist for appropriate patients via pelvic floor muscle therapy, manual therapy, education regarding cardiovascular health, and triage to psychological and sexual counseling. Conclusion: Efficacy is present for this population, but some conditions are more effectively treated conservatively than others.
This work evaluates sperm head morphometric characteristics in adolescents from 12 to 18 years of age, and the effect of varicocele. Volunteers between 150 and 224 months of age (mean 191, n = 87), who had reached oigarche by 12 years old, were recruited in the area of Barranquilla, Colombia. Morphometric analysis of sperm heads was performed with principal component (PC) and discriminant analysis. Combining seminal fluid and sperm parameters provided five PCs: two related to sperm morphometry, one to sperm motility, and two to seminal fluid components. Discriminant analysis on the morphometric results of varicocele and nonvaricocele groups did not provide a useful classification matrix. Of the semen-related PCs, the most explanatory (40%) was related to sperm motility. Two PCs, including sperm head elongation and size, were sufficient to evaluate sperm morphometric characteristics. Most of the morphometric variables were correlated with age, with an increase in size and decrease in the elongation of the sperm head. For head size, the entire sperm population could be divided into two morphometric subpopulations, SP1 and SP2, which did not change during adolescence. In general, for varicocele individuals, SP1 had larger and more elongated sperm heads than SP2, which had smaller and more elongated heads than in nonvaricocele men. In summary, sperm head morphometry assessed by CASA-Morph and multivariate cluster analysis provides a better comprehension of the ejaculate structure and possibly sperm function. Morphometric analysis provides much more information than data obtained from conventional semen analysis.
Sexual dysfunction and prostate cancer are common among older men. Few studies explored the association between these two illnesses. We examined whether sexual function is associated with prostate cancer risk among older men. Among 448 men undergoing prostate biopsy at the Durham Veterans Affairs Hospital, sexual function was ascertained from the Expanded Prostate Cancer Index Composite sexual assessment. We tested the link between sexual function and prostate cancer risk adjusting for multiple demographic and clinical characteristics using logistic regression. Multinomial logistic regression was used to test the associations with risk of low-grade (Gleason ≤6) and high-grade (Gleason ≥7 or ≥4 + 3) disease versus no cancer. Of 448 men, 209 (47%) had a positive biopsy; these men were less likely to be white (43% vs 55%, P = 0.013), had higher prostate-specific antigen (PSA) (6.0 vs 5.4 ng ml-1 , P < 0.001), but with lower mean sexual function score (47 vs 54, P = 0.007). There was no difference in age, BMI, pack years smoked, history of heart disease and/or diabetes. After adjusting for baseline differences, sexual function was linked with a decreased risk of overall prostate cancer risk (OR: 0.91 per 10-point change in sexual function, P = 0.004) and high-grade disease whether defined as Gleason ≥7 (OR: 0.86, P = 0.001) or ≥4 + 3 (OR: 0.85, P = 0.009). Sexual function was unrelated to low-grade prostate cancer (OR: 0.94, P = 0.13). Thus, among men undergoing prostate biopsy, higher sexual function was associated with a decreased risk of overall and high-grade prostate cancer. Confirmatory studies are needed.
Prostate cancer (PCa) is the second most common cancer worldwide in males. The incidence increases with age and positive family history. Most cancers are adenocarcinomas (>95 %), multifocal and originated in the peripheral zone of the prostate. Localized PCa is typically asymptomatic and is discovered through a rise in serum PSA or, less commonly, a suspicious digital rectum examination. Hesitance, urgency, poor urine stream, nocturia and incomplete bladder emptying are the most frequently reported symptoms. Their presence suggests advanced disease. On the other hand, bone pain raises the suspicion of metastatic disease. Transrectal ultrasound guided biopsy is the standard method of diagnosis. Treatment strategy is driven by tumor staging and can include a wide variety of approaches such as active surveillance, surgery, radiotherapy and/or medical therapy. Recently, there was a development of multiple new active treatment modalities, particularly in the setting of advanced disease.
Prostate cancer (PCa) is the second leading cause of cancer-related death in men in the United States. The incidence and mortality of PCa vary widely among different countries in the world, with an overall steady rise in incidence and fall in mortality. However, the disparity between reported incidence and mortality rates since the initiation of screening with PSA is strongly suggestive of an overtreatment of the disease. The growing evidence from genetic studies points to the multiple gene loci rather than specific susceptibility genes to play a major role in inheritable familial predisposition to PCa. Apart from family history, age, and ethnicity, exposure to different environmental factors such as diet, different chemicals, and infections contributes significantly to the risk of development of PCa.
Many factors are implicated in the development of prostatic growth: androgens, growth factors, and stromo-epithelial interaction. This study examines the role of the sympathetic and parasympathetic branches of the autonomic nervous system control of different aspects of rat prostate growth and atrophy. Unilateral sympathectomy leads to decreases in ventral prostate weight, DNA, and protein content in the lesioned side. Unilateral parasympathectomy leads to increases in ventral prostate weight, DNA, and protein content in the intact side. The separate effects of sympathectomy and parasympathectomy are maintained across a diverse combination of neural manipulations. Significant re-innervation does not occur by 60 days after manipulation as assessed by tissue norepinephrine levels. There appears to be a differential effect of the autonomic nervous system on growth and maintenance of the ventral prostate. The mechanism of contralateral hyperplasia and ipsilateral atrophy has potential significance in understanding human abnormal prostate growth.
A population-based case-control study was conducted in men aged 60 or less to assess the risk of prostate cancer associated with vasectomy and other factors. Data were obtained from 216 case-control pairs by telephone interviews; this number represented 55% of all eligible cases. The matched pairs relative risk (RR) for vasectomy in ever married men was 1.4 with a 95% confidence interval (CI) of 0.9-2.3. There was a positive association between the number of years since vasectomy and prostate cancer risk (1-sided P = 0.01). Early age at first sexual intercourse was associated with increased prostate cancer risk (age less than 17 vs. 21+, RR = 2.3, 95% CI = 1.3, 4.0) but there were no consistent associations with number of sexual partners or frequency of sexual intercourse. Cigarette smoking was also associated with increased risk of prostate cancer (RR = 1.9, 95% CI = 1.2, 3.0) and there was a positive dose-response relationship with years of smoking (1-sided P = 0.001). We discuss the possible implication of the low response rate on each of these findings. To determine whether the association with vasectomy might have a hormonal basis, we compared levels of testosterone (T) and testosterone binding globulin-binding capacity (TeBG-bc) in 33 of the vasectomized control men with levels in 33 non-vasectomized controls of the same age, weight and height. T levels were higher in vasectomized than in non-vasectomized controls (1-sided P = 0.06). The ratio of T to TeBG-bc (an index of bioavailable T) was 13.5% higher in vasectomized men (1-sided P = 0.03).
Many factors are implicated in the development of prostatic growth: androgens, growth factors, and stromo-epithelial interaction. This study examines the role of the sympathetic and parasympathetic branches of the autonomic nervous system control of different aspects of rat prostate growth and atrophy. Unilateral sympathectomy leads to decreases in ventral prostate weight, DNA, and protein content in the lesioned side. Unilateral parasympathectomy leads to increases in ventral prostate weight, DNA, and protein content in the intact side. The separate effects of sympathectomy and parasympathectomy are maintained across a diverse combination of neural manipulations. Significant re-innervation does not occur by 60 days after manipulation as assessed by tissue norepinephrine levels. There appears to be a differential effect of the autonomic nervous system on growth and maintenance of the ventral prostate. The mechanism of contralateral hyperplasia and ipsilateral atrophy has potential significance in understanding human abnormal prostate growth.
To analyse the relationship between marital status, indicators of sexual activity, history of urological and venereal diseases, and the risk of prostatic cancer.
Case-control study.
A network of cooperating hospitals from northern Italy.
A total of 271 patients with histologically confirmed prostatic cancer and 685 controls in hospital because of acute, non-neoplastic, non-genital or urological conditions.
Relative risks (RR) and the corresponding 95% confidence intervals (CI) derived from multiple logistic regression equations, including terms for age, area of residence, and education were determined. The risk of prostatic cancer was lower in never married than in married men (RR = 0.6), but not significantly so. Cases reported a significantly higher number of marriages than control subjects, and the RR was 3.2 (95% CI = 1.2, 8.9) for two or more marriages compared with never married men. Prostatic cancer patients also reported being significantly older at the time of their first marriage: compared with men who first married under age 25 years, the RR was 1.6 for marriage at age 25 to 29, and 1.8 for age 30 or more. With regard to urological or venereal diseases, only cystitis and nephrolithiasis were more frequently reported by cases, although there was no tendency for the risk to increase with the number of cystitis episodes and the RR decreased for longer periods since the first episode.
Although these results do not show a totally cohesive picture, they confirm that some aspects of sexual lifestyle are associated with prostatic cancer in Italy.
One hundred and one patients with histologically confirmed prostate cancer and 202 hospital controls individually matched by age (+/- 2 years), hospital admittance and place of residence, were interviewed during the period 1990-94 in two towns in central Serbia (Yugoslavia). In an analysis using multivariate logistic regression, the followng factors were significantly related to prostate cancer: (1) occupational physical activity during the year preceding the disease [odds ratio (OR)=3.87, 95% confidence interval (95% CI)=2.09-7.16]; (2) occupational exposure to asbestos, steel, dyes and lacquers, bitumen, pitch, iron, nickel, lead, fertilizer and certain other agents (OR=2.13, 95% CI=1.05-4.32); (3) nephrolithiasis (OR=4.52, 95% CI=1.34-15.30); (4) 'other' diseases in medical history such as chronic bronchitis, chronic rheumatic diseases, hypertension, cardiomyopathy, diabetes mellitus, renal diseases, eye diseases and tuberculosis (OR=3.14, 95% CI=1.56-6.33); (5) a greater number (> or = 3) of brothers (OR=2.08, 95% CI=1.35-3.22); and (6) greater numbers (> or = 8) of sexual partners (OR=2.24, 95% CI=1.13-4.44). Marital status, age at first marriage, educational level, age at first sexual intercourse, frequency of sexual intercourse, venereal diseases, tonsillectomy, appendectomy, hernia inguinale and hydrocele, anthropometric characteristics, smoking history, sport and recreational activities and family history of prostatic neoplasms were not found to be independently related to prostate cancer.
This article explores the relationship between sociopsychological factors, sexual activity, and sexual satisfaction in a sample
of 1,216 elderly people (mean age = 77.3). Almost 30% hadparticipated in sexual activity in the past month and 67% were satisfied
with current level of sexual activity. Men are more likely to be sexually active, but less apt than women to be satisfied
with their level of sexual activity. Regarding predictors of sexual activity, for men the strongest predictors were being
younger and having more education. For women, the strongest predictor by far was being married. For both men and women the
strongest predictors for satisfaction were being sexually active and having positive mental health scores.In summary, the
main variables predicting sexual activity were being married, having more education, being younger, being male, and having
good social networks. The main predictors for satisfaction with sexual activity were, in addition to being sexually active,
being female,having good mental health, and better functional status.
A population-based case-control study was carried out among 981 men (479 black, 502 white) with pathologically confirmed prostate cancer and 1315 controls (594 black, 721 white). In-person interviews elicited information on sexual behaviour and other potential risk factors for prostate cancer. Blood was drawn for serologic studies in a subset of the cases (n = 276) and controls (n = 295). Prostate cancer risk was increased among men who reported a history of gonorrhoea or syphilis (odds ratio (OR) = 1.6; 95% confidence internal (CI) 1.2-2.1) or showed serological evidence of syphilis (MHA-TP) (OR = 1.8; 95% CI 1.0-3.5). Patterns of risk for gonorrhoea and syphilis were similar for blacks (OR = 1.7; 95% CI 1.2-2.2) and whites (OR = 1.6; 95% CI 0.8-3.2). Risks increased with increasing occurrences of gonorrhoea, rising to OR = 3.3 (95% CI 1.4-7.8) among subjects with three or more events (Ptrend = 0.0005). Frequent sexual encounters with prostitutes and failure to use condoms were also associated with increased risk. Syphilis, gonorrhoea, sex with prostitutes and unprotected sexual intercourse may be indicators of contact with a sexually transmissible factor that increases the risk of prostate cancer.
The association of geographic/racial heterogeneity of prostate cancer rates with the effects of migration has been interpreted as evidence of the impact of environmental factors on the risk of prostate tumorigenesis. A number of epidemiologic studies have supported the hypothesis that ethnic differences observed in prostate cancer rates are attributed to cultural variations in male sexual behavior. Several case-control investigations have also suggested the association of prostate cancer with sexual history particularly the history of sexually transmitted disease but such relations have not been firmly established. Furthermore virologic studies have initially focused on herpes viruses since it was thought that such agents play a major role in cervical cancer. Although the herpes viruses are human cancer viruses there is little evidence on the effect of herpes viruses on the risk of prostate cancer. In this regard researches have focused on the etiologic role of human papillomavirus (HPV) in prostate cancer. However inconsistency of HPV detection in prostate cancer cells is noted due to failure of studies using sensitive polymerase chain reaction assays in contrast to its marked association with cervical cancer. In this regard the search for an infectious etiology of prostate cancer would require a special commitment by researchers epidemiologists and clinicians to overcome high costs and risks of failures.
PURPOSE: Although there is strong circumstantial evidence that androgens are implicated in the etiology of prostate cancer, epidemiologic investigations have failed to demonstrate consistently that one or more steroid hormones are implicated. In contrast, recent epidemiologic studies unequivocally link serum insulin-like growth factor 1 (IGF-1) levels with risk for prostate cancer.
METHODS: We have performed the first meta-analysis of all previously published studies on hormonal predictors of risk for prostate cancer.
RESULTS: A meta-analysis restricted to studies that performed mutual adjustment for all measured serum hormones, age, and body mass index indicated that men whose total testosterone is in the highest quartile are 2.34 times more likely to develop prostate cancer (95% confidence interval, 1.30 to 4.20). In contrast, levels of dihydrotestosterone and estradiol do not seem to play a role of equal importance. The only study that provides multivariably adjusted sex hormone–binding globulin data indicates that this binding protein is inversely related to prostate cancer risk (odds ratio, 0.46; 95% confidence interval, 0.24 to 0.89). Finally, all three studies that examined the role of serum IGF-1 have consistently demonstrated a positive and significant association with prostate cancer risk that is similar in magnitude to that of testosterone.
CONCLUSION: Men with either serum testosterone or IGF-1 levels in upper quartile of the population distribution have an approximately two-fold higher risk for developing prostate cancer.
A population-based case-control study of prostate cancer was performed in King County, Washington, in White men and Black men aged 40-64 years, between 1993 and 1996. Incident prostate cancer cases (n = 753) were identified from the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. Controls (n = 703) were identified through random digit dialing and were frequency matched to cases on age. Sexual behavior, medical history, and other potential prostate cancer risk factors were ascertained through an in-person interview. There was no relation between sexual orientation and prostate cancer, although the number of men who had sex with men was small. Risk estimates increased directly with the lifetime number of female sexual partners (trend p < 0.001) but not with male partners (trend p = 0.62). Risk also increased with decreasing age at first intercourse, but this effect disappeared after adjusting for the number of female partners. Prior infection with gonorrhea was positively associated with risk (odds ratio = 1.50; 95% confidence interval: 1.0, 2.2), but no effect was seen among men with other sexually transmitted diseases. No relation between lifetime frequency of sexual intercourse and risk of prostate cancer was apparent. These findings are consistent with previous studies that support an infectious etiology for prostate cancer.
Dietary and lifestyle characteristics were evaluated in relation to subsequent prostatic cancer risk in a cohort of approximately 14,000 Seventh-day Adventist men who completed a detailed lifestyle questionnaire in 1976 and who were monitored for cancer incidence until the end of 1982. During the 6-year follow-up period, 180 histologically confirmed prostatic cancers were detected among some 78,000 man-years of follow-up. Increasing educational attainment was associated with significantly decreased risk of prostate cancer in this study; age at first marriage was also inversely associated with risk, although this was not significant. There was no relationship between body mass index (as measured by Quetelet's Index) and risk. A history of prostate “trouble” was associated with a 60% increase in risk which was highly significant. Although there were suggestive relationships between increasing animal product consumption and increased risk, these results did not persist after accounting for the influence of fruit and vegetable consumption. Nor was exposure to the vegetarian lifestyle during the childhood years associated with alterations in subsequent risk. However, increasing consumption of beans, lentils and peas, tomatoes, raisin, dates, and other dried fruit were all associated with significantly decreased prostate cancer risk.
OBJECTIVE
To assess whether prostate cancer might be related to hormone levels and, by inference, to differences in sexual activity.PATIENTS, SUBJECTS AND METHODS
In a case-control study of men with prostate cancer aged < 70 years at diagnosis and age-matched control subjects, information was collected on two aspects of sexual activity; the number of sexual partners and the frequency of total ejaculations during the third to fifth decades of life.RESULTSThere was no association of prostate cancer with the number of sexual partners or with the maximum number of ejaculations in 24 h. There was a negative trend (P < 0.01) for the association between risk and number of ejaculations in the third decade, independent of those in the fourth or fifth. Men who averaged five or more ejaculations weekly in their 20s had an odds ratio (95% confidence interval) of 0.66 (0.49–0.87) compared with those who ejaculated less often.CONCLUSIONS
The null association with the number of sexual partners argues against infection as a cause of prostate cancer in this population. Ejaculatory frequency, especially in early adult life, is negatively associated with the risk of prostate cancer, and thus the molecular biological consequences of suppressed or diminished ejaculation are worthy of further research.
Histochemical, immunohistochemical, electron microscopic, and x-ray microanalytic studies were performed on crystalloids within glandular lumina of adenocarcinomas of the prostate. In a review of light microscopic sections of 343 prostatic adenocarcinomas, unequivocal crystalloids were identified in 35 cases (10.2%). Immunohistochemical and ultrastructural studies revealed distinct differences between these crystalloids and the Bence Jones crystals of multiple myeloma: anti-kappa and anti-lamda immunostaining was negative, and the characteristic lattice-like architecture of Bence Jones crystals was not seen. Differences from corpora amylacea also were demonstrated. X-ray microanalysis did not elucidate the nature of the prostatic crystalloids, and their biochemical composition and mode of formation remain uncertain. Detection of the crystalloids in light microscopic sections nevertheless can aid in the diagnosis of prostatic adenocarcinoma, particularly when the tissue is distorted by crushing artifact, or if the tumor is so well-differentiated that it can be confused with atypical hyperplasia or inflammatory atypia. When intraluminal crystalloids are detected in prostatic glands that appear histologically benign or atypical, study of additional levels or a repeat biopsy should be undertaken. Cancer 57:2397–2407, 1986.
• In a questionnaire study, men with prostate cancer (n=155) or benign prostatic hyperplasia (n=131) identified more sexual problems than did men from the general population (n=129). Sexual dysfunction was acknowledged regarding sexual pleasure and attraction, erectile function and sexual satisfaction and sexual performance.
• Lowered rates of sexual desire, pleasure and attraction were found when comparing their situation in recollection of pre-treatment situation to the current situation. Lower intercourse frequency and sexual satisfaction were also found.
• Medication, masturbation and artificial aids to achieve erection were not used as substitutes for shortcomings of erectile function either by men with prostate cancer and benign prostatic hyperplasia nor by their partners.
• There seemed to be a lack of information about the illness and treatment consequences for sexual life, including what physical dysfunction to expect after surgery and also what possible help to expect to compensate for the shortcomings.
Previously undemonstrated protein crystalloid structures were found to occur in the malignant acini of prostatic carcinomas in 23% of cases systematically reviewed. Histochemically and immunohistochemically, they appear closely related, if not identical, to Bence-Jones crystals. Thus, the prostatic carcinoma cell is the first neoplastic cell besides those of the lymphocytic-plasmacytic series shown to produce such crystalline structures. Like the proteolytic splitting of amyloid from Bence-Jones proteins, it is postulated that prostatic epithelium may enzymatically split corpora amylacea from a Bence-Jones-like protein which it synthesizes. It is further postulated that malignant prostatic cells may lack the necessary enzymatic machinery to accomplish this with resultant accumulation of crystalloids within their acini. Prostatic crystalloids were never found in benign glands with rare exceptions and then were limited to benign appearing glands adjacent to carcinoma. The presence of such crystalloids in microscopic sections of prostate may be of diagnostic aid in determining the presence of malignancy or of a premalignant state.
In 1976, we designed an original questionnaire, consisting of 111 questions, directed at the epidemiology of prostatic disease. A case-control study by matched-pair analysis was conducted on 100 controls matched for age within 1 year and for residence in the same prefecture. Patients with prostatic cancer were distinguished from the general population of men by the following characteristics: 1) belonging to middle or lower socioeconomical class, 2) marriage at a young age and a long married life, 3) precocity, 4) vigorous sexual life followed by a fall-off of sexuality in later life, and 5) Western food habits. Based on analysis of results obtained in this case-control study, a high-risk group for prostatic cancer was outlined.
Intraluminal prostatic crystalloids (IPC) are more common in prostate cancer acini than in benign acini. This study was undertaken to evaluate the hypothesis that crystalloids seen in a benign biopsy may indicate an increased risk of a concomitant prostatic carcinoma. A total of 600 patients underwent more than one prostate biopsy. For 394 patients the results of the biopsy were either negative or positive for prostate cancer. After exclusion of patients whose biopsy results were considered negative but coded as high-grade prostatic intraepithelial neoplasia or were suspicious for cancer or whose slides were unavailable for review, 331 patients remained. Biopsy results for these patients were evaluated for the presence of IPC. Also, 18 completely-embedded benign prostates from cystoprostatectomy specimens from patients with bladder cancer were evaluated for the presence of IPC. Seven hundred twenty-five biopsy specimens were reviewed; 51 (7%) contained crystalloids. Thirty-two of 634 (5%) benign biopsy specimens and 19 of 91 (21%) prostatic carcinoma biopsy specimens contained crystalloids. Sixteen of 331 patients (5%) had crystalloids in the initial benign biopsy specimen; 6 patients subsequently were determined to have carcinoma (38%), and 10 continued to have negative results (62%). Three hundred fifteen initial benign biopsies did not show crystalloids; 83 (26%) patients were subsequently diagnosed as having prostatic carcinoma (p = 0.238, Fisher's Exact Test, chi-square test). The IPC were found in 5 of 18 cystoprostatectomy prostates (28%). In this study, the presence of IPC on the initial biopsy specimens was not a significant risk factor for a subsequent diagnosis of prostate cancer. The IPC were not uncommon in prostates without cancer.
From comparisons of prostatic cancer patients with matched control patients for selected risk variables, patients are characterized by three main trends: (a) delayed sexual drive and development, (b) early repression of sexuality, and (c) premature cessation of sexuality. Excessive numbers of patients reported occupational exposure to fertilizers and auto exhaust fumes. Diets of the patients were higher in animal fats. No differences were found between both groups for frequencies of multiple marriages or sex partners, nor for stressful effects from selected events early or late in life. Trends for circumcision and other variables are presented. The data suggest that early differences are hormonally conditioned, support a provisional endogenous rationale for initiation of prostatic cancer, and oppose a hypothesis favoring transmissible oncogenic agents. If results continue to hold up with increased sampling, limitation upon sexual activity at any time of life may increase risk.
Prostate cancer is the most commonly diagnosed form of malignant neoplasia in men. Considerable evidence has accumulated suggesting that paracrine interactions between stromal cells and epithelial cells mediate, in part, the growth and development of the prostate. A nerve growth factor-like protein secreted by stromal cells has been implicated in the paracrine regulation of prostate epithelial tumor cell growth in vitro. This prostate-derived nerve growth factor-like protein differs from the known members of the neurotrophin family of proteins, and may represent a prostate-specific form of this family of gene products. Furthermore, corresponding nerve growth factor receptors have been localized to the epithelial cells of the human prostate in vivo, consistent with a role of the receptors and the adjacent nerve growth factor-like protein secreted by stromal cells, in the paracrine regulation of prostate growth and neoplasia.
Perspective and prospective considerations of the immunoregulatory properties of seminal plasma and their biological and/or clinical relevance are presented. Further understanding of the interactions of the immune system with exocrine products of the male reproductive system may contribute to improvements in reproductive health and to an understanding of the antithetical aspects of the immune response represented by such biological phenomena as insemination, pregnancy and malignancy.
A case-control study of prostatic cancer was carried out to examine the association between selected physical characteristics and factors related to sexual development and behaviour and the risk for this disease. In consideration of an endocrinologic mechanism for these putative risk factors, the association between selected factors and serum hormone level in a comparison group, free of prostate cancer, was also examined. One-hundred cases and 113 controls were included for study. An elevated risk for prostatic cancer was found for those currently married (odds ratio (OR) = 4.0), those who had been married once (OR = 2.8), and those who were currently practising a religion (OR = 2.0). Compared to subjects with one child, those with more than one child and those with no children were more common among cases than controls. Prostatic cancer risk was associated with large body size and, in particular, with greater weight (p < 0.01). Early age at attainment of adult height was also associated with prostatic cancer risk (p < 0.01). Only moderate associations were found between increased frequency of sexual intercourse and prostatic cancer risk. The levels of testosterone (T), dihydrotestosterone, salivary testosterone and T/SHBG (sex hormone binding globulin) did not vary with age. Older men had higher oestradiol levels. Further, little association between hormone levels and risk factors was found, except for married subjects having increased serum androgens (p < 0.05) and heavy subjects having decreased serum androgens (not significant).
Postnatal development of the human prostate proceeds in the phases: (i) a regression period after birth, (ii) a quiescent period up to 12-14 years, and (iii) a maturation period between 14 and 18 years. During postnatal development no lobe formation is observed, but rather a differentiation gradient within the epithelial ducts. Morphogenesis and differentiation of the epithelial cords starts in an intermediate portion of the epithelial anlage and proceeds to the urethral and subcapsular portions. The latter is reached by about 17-18 years. Epithelial anlagen initially consist of a multilayered squamous or cuboidal epithelium which is transformed into a pseudostratified epithelium consisting of secretory, basal, neuroendocrine and mucous cells. The latter are lost during maturation. Secretion starts in adluminal cells (on day 12 in rat) which represent the major compartment of dividing cells. Onset for the expression of different secretory proteins (acid phosphatase, prostate specific antigen, beta-microseminoprotein) is identical in the individual secretory cell of the human prostate. Immature glandular outpocketings display a positive immunoreaction for basic fibroblast growth factor (bFGF) in the epithelium. Since no sign of leakage into the stroma is visible, the action of bFGF during epithelial/stromal interaction remains to be established.
Sexual Behavior Among Married Persons 60 Years Of Age And Older Was Examined Using Data From The National Survey of Families
and Households. About 53 Percent of The Entire Sample, and 24 Percent of Those 76 Years of Age And Older, report having had
Sexual relations at least once within the past Month. persons who have been sexually active within the past month report having
sex about four times during the month. while respondent's age is significantly related to sexual behavior, the monthly incidence
and overall sexual frequency variables are not influenced by gender, race, or a Gender By Spouse'S Health Status Interaction
term. While The NSfh variables included in our model are poor predictors of elderly persons' Sexual Behavior, analyses reveal
that a person's sense o self-worth/competence and his/her partner's Health Status Are Significantly and positively related
to the incidence of sex within the past month.
The authors evaluated the reproducibility and validity of alcohol consumption measured by a mailed, self-administered questionnaire in two large prospective studies. Subsamples of 173 women and 136 men from these cohorts completed two food-frequency questionnaires and multiple 1-week diet records (four for women and two for men) and provided a fasting blood sample. Intakes of alcohol reported over the previous year by food frequency questionnaire 2 correlated highly with intake assessed by multiple week diet records completed over this period (Spearman r = 0.90 in women and 0.86 in men). Mean daily alcohol intake as assessed by the diet records and the questionnaires was very similar. Serum high density lipoprotein cholesterol levels were significantly correlated with alcohol intakes estimated from the questionnaire (r = 0.40 in women and 0.35 in men) and for the diet records (r = 0.33 in women and 0.38 in men). Four years after completing the diet records, women were asked to report their alcohol intake of 4 years earlier; this estimate was highly correlated with the diet records (r = 0.84) and with the earlier high density lipoprotein cholesterol (r = 0.40). These data suggest that a simple self-administered questionnaire can provide useful estimates of alcohol intake over an extended period of time in subjects participating in prospective epidemiologic studies.
A case-control study on prostatic cancer was conducted in Kyoto, Japan, from 1981-1984, including 100 patients with prostatic cancer (PC) and age, hospital, and date-of-admission matched controls of benign prostatic hyperplasia (BPH) patients and general hospital patients. Analysis of several sexual factors obtained through a self-administered questionnaire revealed the following observations: 1) cancer patients had fewer sex partners before marriage (relative risk, RR = 0.35; 95% confidence interval: 0.13-0.93) than the hospital controls; 2) they had more vigorous sexual activities in the third (RR = 2.89; 1.01-8.28) and fourth decades of life (RR = 2.26: 1.03-4.95) than hospital controls, but no significantly different sexual activities from controls in other decades; 3) they had less frequent orgasms (RR = 2.55; 1.11-5.83) than BPH controls or (RR = 4.96: 1.78-13.9) hospital controls, and sexual intercourse appeared to be less satisfactory (RR = 2.08: 1.05-4.13) than that of hospital controls; and 4) they had less frequent episodes of sexually transmitted diseases (RR = 0.36: 0.16-0.83) than BPH controls. Marital status, fertility, ejaculation, masturbation, nocturnal emission, contraceptive use, and wife's episodes of sexually transmitted disease were not linked to prostatic cancer risk.
The authors examined the effect of age on sexual function and behavior and on nocturnal penile tumescence in 65 healthy married men aged 45 to 74 years. There was a significant negative relation between age and sexual desire, arousal, and activity and an increasing prevalence of sexual dysfunction with age but no age difference in sexual enjoyment and satisfaction. Significant age-related decreases in frequency, duration, and degree of nocturnal penile tumescence were found. Sexual desire, arousal, coital frequency, and prevalence of erectile problems correlated with nocturnal penile tumescence measures. The authors discuss the relevance of these findings for the understanding of sexual function in aging men.
The effects of 9 months of aerobic exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality were studied in 78 sedentary but healthy men (mean age, 48 years). The men exercised in supervised groups 60 min per day, 3.5 days per week on average. Peak sustained exercise intensity was targeted at 75-80% of maximum aerobic working capacity. A control group of 17 men (mean age, 44 years) participated in organized walking at a moderate pace 60 min per day, 4.1 days per week on average. Each subject maintained a daily diary of exercise, diet, smoking, and sexuality during the first and last months of the program. Beneficial effects of chronic, vigorous exercise on fitness and coronary heart disease risk factors were obtained in close agreement with prior studies. Analysis of diary entries revealed significantly greater sexuality enhancements in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness.
To identify risk factors for prostate cancer and to try to explain the high risk of blacks relative to whites, case-control interview studies of prostate cancer were conducted in both populations in southern California. Both studies included 142 pairs of cases and population controls matched on age. Cases in blacks were identified by the population-based tumor registry of Los Angeles County and cases in whites were identified by a population-based tumor registry of a southern California retirement community. A past history of venereal disease was associated with a high risk of prostate cancer in both populations [relative risk (RR) = 2.3 in whites; RR = 1.7 in blacks]. The result in blacks was statistically significant (P = .03). Black cases tended to have more frequent sexual intercourse than black controls at all ages; the difference became statistically significant for intercourse late in life. Data from controls suggested that, overall, blacks have earlier and more frequent sexual activity than whites, but the two populations were dissimilar in social class characteristics. Fat intake was a risk factor for prostate cancer in both populations, but vitamin A consumption and protein intake were inconsistently related or unrelated to prostate cancer risk. While beta-carotene was not consistently related to risk, there was some indication that in persons with low fat intake, low beta-carotene intake may be associated with high risk. Circumcision was negatively associated with risk in both populations (RR = 0.5 in whites; RR = 0.6 in blacks). These results are discussed in the context of major etiologic hypotheses for prostate cancer.
A case-control study of a number of factors of possible etiologic significance for prostatic cancer was conducted in the Minneapolis-St. Paul area. The focus was primarily on sexual factors. Two hundred and fifty incident cases of prostatic cancer, 238 hospital controls, and 240 neighborhood controls were included. Controls were matched to cases on age, sex, and race. Cases were somewhat more educated than controls. An association was found between prostatic cancer and a history of venereal disease in their sexual partners: odds ratio (OR) = 2.71, 95% confidence interval (CI) = 1.14 to 6.46 and OR = 2.09, 95% CI = 1.02 to 4.29 for hospital and neighborhood controls, respectively. Cases had more sexual experiences with prostitutes, although their overall lifetime frequency of sexual intercourse with all partners was somewhat lower. Cases also reported more homosexual partners than controls. The results from the study lend some support to an infectious hypothesis for prostatic cancer. The lower frequency of sexual intercourse (OR = .54, 95% CI = .34 to .83 and OR = .68, 95% CI = .47 to 1.01 for hospital and neighborhood controls, respectively) is also noteworthy and may be indicative of a hormonal difference related to sexual interest or drive.
A special epidemiologic questionnaire was administered to 221 patients with prostatic cancer, age and race-matched to 221 patients with noncancerous, nongenitourinary conditions from various Los Angeles area hospitals. All control patients also underwent rectal examination and had normal prostatic acid phosphatase examinations to insure that there were no latent cases of prostatic cancer that would obscure comparative differences.There was a statistically significant (P < 0.05) excess of familially associated prostatic cancers, past history of venereal disease, coital frequency, number of sexual partners before marriage, and the use of contraceptive agents in the prostatic cancer cases versus the controls. In contrast to earlier studies, there was no significant difference between cases and controls for the variable of number of sexual partners after marriage.
Attention is drawn to the importance of prostate cancer in terms of morbidity and mortality among males in Canada and elsewhere. A resume is presented of some of the more notable epidemiologic factors found to be associated with the disease. A retrospective study of histologically confirmed prostate cancer in 39 patients hospitalized is described. Each patient was matched with another patient having a non-genito-urological, non-cancerous condition. A second group of patients with benign hyperplasia of the prostate was also used for comparative purposes. Among the major areas covered in the study are social and demographic factors, personal and family history of illness and sexual habits. The most striking findings relate to sexuality and in particular extra-marital activity; the engagement in sexual relationships with multiple partners ; greater sexual drive and the greater frequency of venereal disease among the cancer group of patients.Reference is made to certain similarities between the epidemiology of cancer of the Sexual Factors in the Epidemiology of Cancer of the Prostate 37 cervix and cancer of the prostate, as described, with regard to sexuality. The possibility of a sexually transmitted virus infection being the aetiological factor in the production of cancer of the prostate is considered. Recommendations are made for further study with particular reference to the exploration of a viral-venereal or hormonal aetiology.
A laboratory based epidemiologic study was done to determine the possible relationship of herpesvirus type 2 to carcinoma of the prostate. A total of 305 patients (224 with benign prostatic hypertrophy and 81 with prostatic carcinoma) who underwent transurethral resection of the prostate was studied. Viral cultures were obtained from urethral swabs and urine preoperatively. Prostatic tissue removed at operation was grown as tissue explants, using a monolayer cell culture technique, and examined by specific immunofluorescence and electron microscopy for evidence of herpesvirus type 2. The sera of the patients also were tested for specific antibody to herpesvirus type 2 by the indirect hemagglutination inhibition test. Although herpesvirus was not isolated 5 per cent of the patients had evidence of herpesvirus type 2 antigen in prostatic tissues by specific immunofluorescence. Electron microscopy failed to reveal the presence of viral particles. There was an increased prevalence of herpesvirus type 2 antibody in patients with carcinoma of the prostate compared to the controls with benign prostatic hypertrophy (p less than 0.05). Although marital status was similar the patients with prostatic cancer tended to marry at an earlier age, have more children, more sexual partners and more exposure to prostitutes than their counterparts with benign prostatic hypertrophy. The demonstration of specific herpesvirus type 2 antibody in patients with prostatic cancer supports an etiologic role for herpesvirus type 2 but further studies are needed to describe more definitively the relationship since the indexes of sexual activity are remarkably high in both groups.
The two most important demographic characteristics of prostate cancer in Los Angeles are the high rates among blacks, which are two times those among whites and four times those among Asians, and the rapid increase in rates with age after age 40. Despite the high rates among blacks, a birth cohort analysis indicates that mortality rates among black men born after 1900 have decreased. In this report, epidemiologic and experimental evidence supporting each of three etiologic hypotheses--industrial exposure to cadmium, sexual transmission by an infectious agent, and endocrine factors--are reviewed. Evidence from descriptive data in Los Angeles suggests that only a small portion of cases might be attributable to industrial exposures. In a cohort study of Catholic priests, we found no deficit of prostate cancer mortality, strong evidence against sexual transmission of the disease. Experimental evidence and a limited amount of human data support an endocrine hypothesis. Preliminary results of a case-control study of prostate cancer are presented, but these results are unable to distinguish among these hypotheses further. This study finds a substantial protective effect of vasectomy, an event that is accompanied by reduced prostatic function and size, but this result is thus far statistically insignificant.
In this paper, studies by a large series of independent investigators are reviewed with regard to the basic structure and function of the prostate in an attempt to examine their relationship to prostatic cancer etiology. These studies demonstrate that the functional activities of the prostate involve secretion, transport, and reabsorption of a variety of materials into and out of the glandular lumen and that these activities are directly related to the basic structural organization of the gland. These functional activities are constantly occurring in the prostate even under basal (ie, nonejaculating) conditions. Due to these functional activities, the prostatic fluid in the glandular lumen is a complex mixture of a variety of components derived, not only from the synthetic activity of the glandular epithelial cells of the gland itself, but also from the blood serum. The levels of these components are continuously modulated, not only by the frequency of active ejaculation, but also, under basal conditions by the continuous interaction with the glandular prostatic cells lining the acinar lumen and ducts. A concept is presented that the initiation and/or promotion of prostatic carcinogenesis may well involve the chronic modulation/interaction of the prostatic glandular cells with their lumenal fluid.
Because the prostate of laboratory animals seems relatively resistant to the carcinogenic effects of systematically administered chemicals--an observation of some significance in attempts to establish the etiology of human prostatic adenocarcinoma and to produce animal models of prostatic cancer--we studied the penetration of eight carcinogenic chemicals into both the prostate gland and the prostatic secretion of the dog and the rat. The eight chemicals were 3-methylcholanthrene, 7,12-dimethylbenz[a]anthracene, N-hydroxyurethane, aflatoxin B1, 3-amino-1,2,4-triazole, 2-acetylaminofluorene, N-Methyl-N'-nitro-N-nitrosoguanidine, and cadmium. In both species all eight substances and/or their metabolites were found to rapidly enter the prostate, and all except cadmium were recovered from prostatic fluid. Thus, although the levels in prostatic fluid did not always reflect levels in the gland, there was little if any barrier to the penetration of these chemicals into the gland. The apparent relative refractoriness of the prostate to systematically administered carcinogenic chemicals cannot be due to failure of such substances to enter the gland.
Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.7% and at an age-adjusted incidence rate (world standard) of 40.6% per 1000 necropsies in the sampled black male population. The frequency of microcarcinoma of the prostate in black males in Washington, D.C., is essentially the same as the frequency of latent carcinoma in other ethnic groups and in other geographic areas. Of the patients studied clinically, fifty-one percent (51%) were in low stage (Stages I and II) disease; sixty-three percent (62.7%) had a well differentiated, Grade I, carcinoma of the prostate; and forty-two percent (42.4%) were in the 65-74 age group. Mean plasma testosterone and estrone levels were significantly higher in cancer patients than in age-matched hospitalized controls. The factor with the highest risk ratio was urinary tract symptoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis or prostatic carcinoma. Although our studies did not directly implicate diet as a risk factor, published reports strongly suggest diet as a critical factor in the development of prostatic carcinoma.
To document the relative importance of endogenous sex steroids in modulating the frequency of orgasms, the dominant aspect of sexual behaviour in healthy eugonadal men.
Measurement of adrenal and testicular sex steroids in a sample of army recruits and study of their relation to frequency of orgasms ascertained by questionnaire after potential confounding variables were controlled for.
Military campus and military hospital laboratories in Athens, Greece.
92 consecutively enrolled healthy male recruits aged 18-22 years.
Weekly number of orgasms. Serum concentrations of testosterone, dehydroepiandrosterone sulphate, dihydrotestosterone, oestradiol, oestrone, delta-4-androstenedione, and sex hormone binding globulin.
Serum dihydrotestosterone concentration was the only independent hormonal predictor of the frequency of orgasms; an increase in concentration of 1.36 nmol/l (about 2 SD) corresponded to an average increase of one orgasm a week.
Differences in concentrations of circulating dihydrotestosterone within the normal range may represent a major predictor of sexual activity in healthy young men.
One consequence of the acquired immunodeficiency syndrome (AIDS) epidemic has been to highlight the need for population-based estimates of the number of individuals engaging in sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. This paper describes the prevalence of various sexual behaviors in a nationally representative sample of adults in the United States.
Data were collected as part of a household probability survey of adults (n = 2058) in the United States. Data collected on sexual behavior included sexual orientation, frequency of intercourse, condom use, and number of sexual partners.
Nearly all respondents were sexually experienced. Of those who were currently sexually active, 13% (1% of married respondents) had had sex with more than one partner in the previous year. Of those reporting having intercourse with more than one partner in the previous year, 7% used condoms consistently and 23% used condoms consistently with their casual partners.
A significant proportion of individuals were found to have intercourse with multiple partners without using condoms. A minority of these respondents acknowledged that their behavior may place them at risk for HIV transmission.
Prostatic intraluminal crystalloids are irregular eosinophilic, non-birefringent structures increasingly recognized as potential indicators of prostatic malignancy. In a study of 250 randomly selected surgical pathology cases of prostatic tissues none of 50 cases of benign glandular hyperplasia (0%), one of 50 cases of atypical adenomatous hyperplasia, 18 of 50 cases of well-differentiated adenocarcinoma (36%), seven of 50 cases of moderately differentiated adenocarcinoma (14%), and none of 50 cases of poorly differentiated adenocarcinoma (0%) revealed intraluminal crystalloids. A histochemical and immunohistochemical staining panel indicated that the crystalloids were nonproteinaceous. Crystalloids were stained intensely with phosphotungstic acid hematoxylin and did not stain for prostatic-specific antigen or hemoglobin. Crystalloids were clearly differentiated from prostatic corpora amylacea on light microscopy, histochemistry, scanning, and transmission electron microscopy. Electron probe x-ray microanalysis of 10 cases of crystalloids revealed uniform high sulfur peaks and small sodium peaks. We conclude that intraluminal crystalloids are associated more frequently with low-grade prostatic adenocarcinoma, may occur in benign tissue bordering adenocarcinoma, are predominantly composed of inorganic sulfur, and their presence in benign and atypical prostate biopsies may be of pathologic significance and should warrant further clinical investigation and possibly repeat biopsy.
We assessed the reproducibility and validity of a self-administered physical activity questionnaire used in a prospective study of 51,529 men. The questionnaire was administered by mail twice to 238 participants 2 years apart. During this interval, the participants completed a past-week recall and a 1-week activity diary at four times corresponding to different seasons throughout a year. Also, a step test was taken by a subset of the study participants. The intraclass correlation coefficients used to measure reproducibility were 0.39 for inactivity, 0.42 for nonvigorous activity, and 0.52 for vigorous activity. The correlations between diary-based and questionnaire-based activity scores, adjusted for variation in the diary measurements, were 0.41 for inactivity, 0.28 for nonvigorous activity, and 0.58 for vigorous activity. The distribution of activity scores was similar between the questionnaires and the average of past-week recalls, indicating the participants' ability to incorporate seasonal variation into their recall on a questionnaire. The correlation between vigorous activity and resting pulse was -0.45, whereas, for the pulse rate after stepping, the correlation was -0.41. These data indicate that this physical activity questionnaire is reproducible and provides a useful measure of average weekly activity, particularly vigorous activity, over a 1-year period.