Document Type : Systematic Review and Meta-analysis
Authors
1
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
2
Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara-Haji Adam Malik General Hospital, Medan, Indonesia.
3
Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia.
4
General Practitioner, Djasamen Saragih Hospital, Pematangsiantar, Indonesia.
Abstract
Introduction: Prostate cancer (PCa) is a multifactorial disease influenced by genetic, hormonal, and lifestyle factors, yet the impact of preceding sexual behaviors remains underexplored. Given the prostate’s fundamental role in male sexual function, this study aims to qualitatively assess the relationship between ejaculation frequency (EF), first sexual activity (FSA), and lifetime sexual partner (SP) count with PCa occurrence in later life. Materials & Methods: A systematic literature review was conducted following PRISMA guidelines, with studies identified through MEDLINE, ScienceDirect, and ProQuest databases. Retrospective cohort and case-control studies published since 2000, examining PCa risk in relation to sexual behaviors in early adulthood (20s–40s), were included. Data extraction focused on EF, FSA, and SP count, and study quality was assessed using the Newcastle-Ottawa Scale. Results: A total of 10 studies with 6,601 PCa cases and 6,208 controls were analyzed. Higher EF from sexual intercourse (SI; ≥5-12 times per month) was associated with a reduced PCa risk, whereas frequent masturbation (≥2-7 times per week) showed a potential risk increase. The influence of FSA was inconsistent, with some studies linking earlier or later initiation to higher risk. A higher lifetime SP count (7-21 partners) was generally associated with increased PCa risk, likely due to sexually transmitted infections and chronic inflammation. Conclusion: Sexual behaviors in younger years may play a role in PCa development, with EF type, FSA, and SP count acting as potential risk modifiers. While high EF from SI may be protective, excessive masturbation and multiple partners could contribute to risk. Further prospective studies are needed to refine recommendations on sexual health and prostate cancer prevention.
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