Male sexuality and the risk of developing benign prostatic hyperplasia and prostate cancer: is there a connection?

Introduction. Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are diseases associated with morphological changes in prostate tissue, which have a proven hormone-dependent pathogenesis. The identification of risk factors for the development of these diseases and the development of an etiological prevention concept are important clinical objectives.

Objective. To assess male sexuality (sexual constitution) as a potential risk factor for BPH or PCa.

Materials & methods. The study included 47 men (Group 1) aged 49 – 71 years with Lower Urinary Tract Symptoms (LUTS) caused by BPH, as well as 87 patients aged 47 – 70 years with a newly diagnosed PCa T 1c-3b N 0-1 M 0-1a. The main laboratory and instrumental parameters (PSA, testosterone, prostate volume) were studied, and an assessment and grading of male sexuality throughout life were conducted using the Rostov Questionnaire.

Results. Among men with BPH, individuals with hypo-, normo-, and hypersexuality are found with approximately equal frequency, while PCa patients are hyposexual in 90.8% of cases, with only 9.2% being normosexual. In the BPH patient group, there is a direct statistically significant relationship between sexuality and testosterone levels, ranging from moderate (total score at the time of diagnosis) to high (early and middle stages of sexual life), p < 0.001. In PCa patients, no relationship between testosterone and sexuality was established (p > 0.05). The identification of the relationship between male sexuality and prostate diseases allowed for the evaluation of three logistic regression models predicting the development of BPH or PCa depending on the level of male sexuality.

Conclusion. Male sexual constitution is a risk factor for the development of BPH and PCa. All three variants of male sexual constitution correlate with blood testosterone levels in BPH, while such correlation is absent in PCa. Numerical values of male sexuality, prostate volume levels, and blood PSA allow determining the likelihood of detecting BPH or PCa in a patient.

1. Jacobsen SJ, Girman CJ, Lieber MM. Natural history of benign prostatic hyperplasia. Urology. 2001;58(6 Suppl 1):5-16; discussion 16. DOI: 10.1016/s0090-4295(01)01298-5

2. Pushkar D.Yu., Rasner P.I. Symptoms of the lower urinary tract and benign prostatic hyperplasia. Urologiia. 2006;3 (suppl.):4-18. (In Russian).

3. Kaprin A.D., Starinskiy V.V., Shakhzadova O.A., eds. Zlokachestvennye novoobrazovaniya v Rossii v 2021 godu (zabolevaemost’ i smertnost’). Moscow; 2022. (In Russian).

4. Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474-479. DOI: 10.1016/s0022-5347(17)49698-4

5. Lopatkin N.A., ed. Adenoma prostaty. Urologiya. Natsional’noe rukovodstvo. Moscow: Gehotar-Media; 2009. (In Russian).

6. Kogan M.I., Vorob’ev S.V., Khripun I.A., Belousov I.I., Ibishev KH.S. Testosteron. Ot seksual’nosti k metabolicheskomu kontrolyu. Rostov-na-Donu: Feniks; 2017. (In Russian).

7. Vickman RE, Franco OE, Moline DC, Vander Griend DJ, Thumbikat P, Hayward SW. The role of the androgen receptor in prostate development and benign prostatic hyperplasia: A review. Asian J Urol. 2020;7(3):191-202. DOI: 10.1016/j.ajur.2019.10.003

8. Dilixiati D, Kadier K, Laihaiti D, Lu JD, Azhati B, Rexiati M. The association between sexual dysfunction and prostate cancer: a systematic review and meta-analysis. J Sex Med. 2023;20(2):184-193. DOI: 10.1093/jsxmed/qdac025

9. Hayes RB, Pottern LM, Strickler H, Rabkin C, Pope V, Swanson GM, Greenberg RS, Schoenberg JB, Liff J, Schwartz AG, Hoover RN, Fraumeni JF Jr. Sexual behaviour, STDs and risks for prostate cancer. Br J Cancer. 2000;82(3):718-725. DOI: 10.1054/bjoc.1999.0986

10. Rider JR, Wilson KM, Sinnott JA, Kelly RS, Mucci LA, Giovannucci EL. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol. 2016;70(6):974-982. DOI: 10.1016/j.eururo.2016.03.027

11. Kogan M.I., Kireev A.Yu. The questionnaire of integral assessment of male sexuality. Urologiia. 2009;(1):46-49. (In Russian). eLIBRARY ID: 12162910; EDN: KGEESH

12. Rosenblatt KA, Wicklund KG, Stanford JL. Sexual factors and the risk of prostate cancer. Am J Epidemiol. 2001;153(12):1152-1158. DOI: 10.1093/aje/153.12.1152

13. Jian Z, Ye D, Chen Y, Li H, Wang K. Sexual Activity and Risk of Prostate Cancer: A Dose-Response Meta-Analysis. J Sex Med. 2018;15(9):1300-1309. DOI: 10.1016/j.jsxm.2018.07.004

14. Kogan M.I., Efremov M.E., Medvedev V.L., Sinyavskaya T.G. Benign prostate hyperplasia and prostate cancer differentiation calculator. Urology Herald. 2025;13(1):13-18. (In Russian). DOI: 10.21886/2308-6424-2025-13-1-13-18

15. Papa NP, MacInnis RJ, English DR, Bolton D, Davis ID, Lawrentschuk N, Millar JL, Pedersen J, Severi G, Southey MC, Hopper JL, Giles GG. Ejaculatory frequency and the risk of aggressive prostate cancer: Findings from a case-control study. Urol Oncol. 2017;35(8):530.e7-530.e13. DOI: 10.1016/j.urolonc.2017.03.007

16. Kogan M.I., Kireev A.Yu. Razlichiya urovnei testosterona i polimorfizma gena androgenovogo retseptora u patsientov s simptomnoi dobrokachestvennoi giperplaziei prostaty v zavisimosti ot seksual’noi aktivnosti. Andrologiya i genital’naya khirurgiya. 2009;(2):118. (In Russian). eLIBRARY ID: 12838183; EDN: KUYJYR