Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", 80121 Naples, Italy.
Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", 80121 Naples, Italy.
Int J Environ Res Public Health. 2021 Aug 11;18(16):8500. doi: 10.3390/ijerph18168500.
Most cancers are related to lifestyle and environmental risk factors, including smoking, alcohol consumption, dietary habits, and environment (occupational exposures). A growing interest in the association between sexual activity (SA) and the development of different types of tumors in both men and women has been recorded in recent years. The aim of the present systematic review is to describe and critically discuss the current evidence regarding the association between SA and male genital cancers (prostatic, penile, and testicular), and to analyze the different theories and biological mechanisms reported in the literature. A comprehensive bibliographic search in the MEDLINE, Scopus, and Web of Science databases was performed in July 2021. Papers in the English language without chronological restrictions were selected. Retrospective and prospective primary clinical studies, in addition to previous systematic reviews and meta-analyses, were included. A total of 19 studies, including 953,704 patients were selected. Case reports, conference abstracts, and editorial comments were excluded. Men with more than 20 sexual partners in their lifetime, and those reporting more than 21 ejaculations per month, reported a decreased risk of overall and less aggressive prostate cancer (PCa). About 40% of penile cancers (PCs) were HPV-associated, with HPV 16 being the dominant genotype. Data regarding the risk of HPV in circumcised patients are conflicting, although circumcision appears to have a protective role against PC. Viral infections and epididymo-orchitis are among the main sex-related risk factors studied for testicular cancer (TC); however, data in the literature are limited. Testicular trauma can allow the identification of pre-existing TC. SA is closely associated with the development of PC through high-risk HPV transmission; in this context, phimosis appears to be a favoring factor. Sexual behaviors appear to play a significant role in PCa pathogenesis, probably through inflammatory mechanisms; however, protective sexual habits have also been described. A direct correlation between SA and TC has not yet been proven, although infections remain the most studied sex-related factor.
大多数癌症与生活方式和环境危险因素有关，包括吸烟、饮酒、饮食习惯和环境（职业暴露）。近年来，人们对性行为（SA）与男性和女性不同类型肿瘤发展之间的关联越来越感兴趣。本系统评价的目的是描述和批判性讨论性行为与男性生殖器癌症（前列腺、阴茎和睾丸）之间关联的现有证据，并分析文献中报道的不同理论和生物学机制。2021 年 7 月，在 MEDLINE、Scopus 和 Web of Science 数据库中进行了全面的文献检索。选择了无时间限制的英语论文。纳入了回顾性和前瞻性的原发性临床研究，以及以前的系统评价和荟萃分析。共选择了 19 项研究，包括 953704 名患者。排除病例报告、会议摘要和社论评论。一生中拥有超过 20 个性伴侣的男性和每月报告超过 21 次射精的男性，患总体和侵袭性较低的前列腺癌（PCa）的风险降低。大约 40%的阴茎癌（PC）与 HPV 相关，HPV 16 是主要的基因型。关于 HPV 在割礼患者中风险的数据存在争议，尽管割礼似乎对 PC 具有保护作用。病毒感染和附睾睾丸炎是研究睾丸癌（TC）的主要与性相关的危险因素之一；然而，文献中的数据有限。睾丸创伤可识别先前存在的 TC。SA 通过高危 HPV 传播与 PC 的发生密切相关；在这种情况下，包茎似乎是一个有利因素。性行为似乎在 PCa 的发病机制中起着重要作用，可能通过炎症机制；然而，也描述了保护性的性行为习惯。SA 和 TC 之间尚未建立直接的相关性，尽管感染仍然是研究最多的与性相关的因素。
