The prostate is a small organ with the shape of a walnut that has been described to play the essential function of producing prostatic secretions that make up about 20% of the entire volume of semen. Prostatic secretions typically contain proteins and enzymes that gives the thick consistency or high viscosity of freshly produced semen. The viscose nature of freshly produced semen is thought to offer sperms, adequate time to utilise the energy nutrients (fructose) in semen. Other enzymes in the prostatic secretions also help to liquify the thick semen within minutes after ejaculation (typically within 15 mins). In the liquified semen, sperms now move actively in a directional motion with the hope to fertilise an egg. So, the prostate plays one of the essential functions in the male reproductive system. Anatomically, it should be noted that the urethra passes through the centre of the prostate gland and pathologies of the prostate gland inevitably affect the urinary stream. Pathologies of the prostate gland include prostatitis, benign prostatic hypertrophy and prostate cancer.
Prostatitis
Prostatitis is an inflammation of the prostate gland and is typically caused by bacteria infections although other microorganisms such as chlamydia and mycoplasma have been noted to cause prostatitis. Prostatitis is easily treated with the use of antibiotics and other antimicrobial agents. A decent review on prostatitis; the causes, diagnosis and treatments can be found here.
Benign prostatic hypertrophy
Benign prostatic hypertrophy (BPH) is the enlargement of the prostate gland and BPH seem to be observed in most older men over the age of 50 years. As mentioned earlier, the urethra runs through the centre of the prostate gland and an enlargement of the prostate is thought to constrict the urethra causing the typical presentation of a reduced or weak urine stream, feeling of incomplete bladder emptying after urinating, urine dribbling, hesitancy in urination, delayed and or prolonged urination. The constricted and reduced inner diameter of the region of the urethra surrounded by the enlarged prostate gland in BPH is thought to be the cause of the above-mentioned symptoms. Treatment interventions for BPH includes medical (use of drugs) and surgical approaches but most physicians apply what has been popularly termed watchful waiting (in men with mild or moderate symptoms of BPH), where they regularly monitor the degree of prostate enlargement and intervene appropriately when required. An excellent scientific review on BPH is presented here.
Prostate cancer
Prostate cancer is simply put an abnormal growth or cancer happening in the prostate gland. Most prostate cancer cases are slow growing, limited to the prostate gland and may not present any symptom at the early stages. However, some cases of prostate cancer are aggressive and is able to spread to affect other nearby and distant tissues and organs. About 75% of prostate cancer cases are diagnosed in men 65 years and older whiles a quarter of the cases are diagnosed in men under 65 years. Symptoms of prostate cancer can be similar as has been listed for BPH and could also include blood in semen, pelvic bone pain and erectile dysfunction.
Like many other cancers, the exact cause of prostate cancer is not certainly known by medical experts. But also like all other cancers, it is known, that when there are some mutations in the DNA of a dividing cell or group of cells, these cells can grow unchecked and unstoppably causing a continuously growing mass of tumour in the prostate. So certainly, the causes of prostate cancer have genetic and environmental triggers. Perhaps one of the most instructive research studies crystallising the genetic or heritable involvement in prostate cancer is the study of about 45,000 pairs of twins in the Swedish, Finnish and Danish twin registries. They report that, in identical twins, one twin stands a significantly increased risk of suffering prostate cancer if the other identical twin has been previously diagnosed with prostate cancer.
Apart from genetics, other predisposing or risk factors for prostate cancer has been noted to include obviously advanced age and not so obviously obesity and ethnicity, with men of African descent reportedly having a higher risk of suffering from prostate cancer than Caucasian men.
Viral infections, chiefly including human papilloma virus (HPV) types 16 and 18 have reportedly been identified in prostate cancer tissues. [HPV is the main cause of cervical cancer in women]. In a number of studies, HPV detection in prostate cancer tissues is said to be between 5 – 60 % of prostate cancers. It should be noted that multiple causes or conditions have been associated with prostate cancers. Lifestyle factors including smoking, alcohol consumption and sexual behaviours have been suggested to contribute to prostate cancer.
Sexual activity and prostate cancer
Sexual behaviour such as the age at first intercourse, frequency of intercourse/ejaculations, masturbation, and the number of female sexual partners have been found one way or the other to be associated as risk factors for the development of prostate cancers albeit with weak or simply non-existent/anecdotal evidence to support some of these claims. Majority of the scientific data on these topics are rather insufficient to make any strong claims as to the possibility of such sexual behaviours to be causative factors of developing prostate cancer. But let’s take a look at some interesting reports in the medical literature on these topics.
A huge meta-analysis on some 50,000 men, having more than 10 female sexual partners were associated with about 1-fold increase in the risk of developing prostate cancer. This same meta-analysis also reports a significant reduction in the risk of prostate cancer in men who had 2 – 4 ejaculations/intercourse per week. A smaller case-control study involving 400 men with prostate cancer and 400 control men (without prostate cancer), report a sort of a double-edged story about the age of first intercourse and the frequency of ejaculations. Whiles men who had early sexual activity and masturbated/ejaculated often in their 20s were at increased risk, men who masturbated often in their 50s had a rather reduced risk of developing prostate cancer.
Some studies have also reported observing a higher risk of prostate cancer in men who had frequent ejaculations. However, rather contrasting claims have been made in another huge study conducted by a team at the Harvard University that focused and collected data from over 30,000 men in the healthcare profession spanning about 20-year period. The Harvard team report that men who had 21 or more ejaculations/intercourse per month had a whooping 36% lower risk than men who only had 4 – 7 ejaculations per month. In a similar study on about 2,500 Australian men, those who had about 7 ejaculations per week had a 40% reduced chance of developing prostate cancer than men who only had about 2 ejaculations per week.
But understandably so, this is perhaps one of the areas of medicine that will prove quite difficult to achieve consensus results on. Considering that most cases of prostate cancer develop well into old age (65 years or more) and these studies will be requiring men to recollect and provide accurate account of their sexual activities in their 20s, 30s and 40s. Practically, this conundrum presents a lot of bias in the data collection process and makes it difficult to first compare studies and even arrive at an agreeable consensus on male sexual behaviour and prostate cancer.
Generally, the good life practice of eating well balanced meals, exercising regularly, being aware of the signs and symptoms and seeing a specialist as soon as possible are key tips to be mindful of to have a healthy prostate.
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