Updated dose-response meta-analysis of sexual activity and prostate cancer risk

This systematic review and meta-analysis aimed to update the evidence on how sexual activity factors, including frequency of intercourse, number of female sexual partners, age at first intercourse, and number of ejaculations and masturbations relate to prostate cancer.

We conducted a comprehensive search across PubMed, Web of Science, and Scopus up to October 19, 2025. We also reviewed existing study references for additional relevant research. To assess study consistency, we used I² statistics. Publication bias was evaluated using Begg and Egger tests. Our analysis reported pooled odds ratios (OR) with 95% confidence intervals using a random-effects model. The research protocol was approved by PROSPERO, ID CRD42024549018.

From 5,311 identified studies, 29 (315,193 participants) met the inclusion criteria. Positive but non-significant associations were observed between prostate cancer and more frequent sexual intercourse (OR = 1.02; 95% CI: 0.88, 1.18), a higher number of female partners (OR = 1.01; 95% CI: 0.90, 1.12), and masturbation frequency (OR = 1.12; 95% CI: 0.82, 1.54). Older age at first intercourse showed a negative but non-significant association (OR = 0.99; 95% CI: 0.90, 1.08), whereas higher ejaculation frequency demonstrated a significant protective effect (OR = 0.83; 95% CI: 0.77, 0.90).

These findings suggest that most sexual behaviors are not significantly associated with prostate cancer risk. However, higher ejaculation frequency appears to have a protective effect. The results highlight the multifactorial nature of prostate cancer and emphasize the need for further research to clarify the role of sexual activity in disease prevention.