（新聞報導）PSA上升 憂攝護腺癌復發！醫師提醒3關鍵

 PSA上升 憂攝護腺癌復發！醫師提醒3關鍵

https://health.ltn.com.tw/article/breakingnews/5546525

 

【仁醫說】PSA高了就要切片嗎？2026最新指南告訴你答案！

  

#仁醫說

「發現  #攝護腺癌  一定要切片檢查嗎？面對切片，許多病人心中充滿著恐懼。」我們一起來看美國泌尿外科學會(AUA)與泌尿腫瘤學會(SUO) 2026年最新修訂的《攝護腺癌篩檢指南》怎麼說？在指引中也提到，PSA偏高不需要立刻切片，應納入更多的綜合性評估包含：

🔹 PSA抽血檢查：由於影響的因素很多，常見包括：射精、劇烈運動、泌尿道感染、攝護腺肥大等，因此，若首次檢測發現PSA值異常，應建議進行複查。

🔹攝護腺MRI（磁振造影）：如同透視眼的MRI，指南中提到，在初次或再次切片前進行，並採用PI-RADS 評分系統（PI-RADS 3～5為異常標的），提高臨床重要癌症的檢出率，同時，降低不必要的切片。

🔹生物標記檢測：當PSA值為輕微升高時，指南中建議，可結合血清、尿液等生物標記，有助於降低不必要的切片率。

📌經會陰切片安全性相對較高

👉攝護腺切片常見的2大途徑以經直腸切片 (Transrectal)與經會陰切片 (Transperineal)，兩者的差異在於

1.  #經直腸切片  (Transrectal Biopsy)

→透過超音波探頭將切片針從肛門穿過直腸中，進行攝護腺切片，因此，有較高的機率會將腸道細菌帶入前列腺或血液。

有研究指出，經直腸切片後發燒性泌尿道感染機率、攝護腺發炎，甚至是敗血症等感染風險機率較高，但在臨床上可以透過搭配抗生素藥物的使用，降低感染風險。

2.  #經會陰切片  (Transperineal Biopsy)

→利用超音波或磁振造影（MRI）的導引，切片針經由會陰部進入攝護腺進行採樣，不需穿過直腸壁，因此，有3大優勢

✅降低感染率：由於經會陰切片不需要直腸，因此，能夠降低腸道細菌帶入血液的機會。

✅安全性高：根據研究指出，經會陰切片的敗血症風險相對來說比直腸切片較低很多。

👉指南指出，經會陰切片與經直腸切片在癌症檢出率上一樣優異，但近來臨床研究認為，經會陰切片具有極高的安全性，對於曾有採樣感染史、高感染風險的患者是篩檢較佳的選擇方式，隨著醫療科技的進步，檢查是能夠精準與安全兼具的，同時不再伴隨恐懼。

👉無論採取經直腸切片或經會陰切片，都必須透過專業的醫師將患者的感染風險、病灶位置、身體狀況與醫療院所的設備，納入綜合評估。

 

Rumor: Can Ejaculating More Than 21 Times a Month Prevent Prostate Cancer?

 

“Doctor, I heard that ejaculating more than 21 times a month can prevent prostate cancer. Is that true?”

 

This claim isn’t entirely baseless.

It originates from a Harvard study published in 2016 in the prestigious journal European Urology (Impact Factor: 23.4).

The study investigated the link between ejaculation frequency and prostate cancer risk, tracking over 30,000 men for 18 years.

 

l  What Did the Study Find?

Let’s delve into the scientific basis behind this research.

-Research Methodology

This large prospective study used data from the Health Professionals Follow-up Study (HPFS).
It involved 31,925 U.S. male health professionals who reported their average monthly ejaculation frequency in 1992.
They were followed for 18 years until 2010.

Participants reported their monthly ejaculation frequency at three life stages: ages 20-29, ages 40-49, and the year prior to the survey.
These data were used to analyze the relationship between ejaculation frequency and prostate cancer risk.

The study employed Cox proportional hazards models to estimate the hazard ratio (HR) and 95% confidence intervals (CI) for prostate cancer incidence.
Participants were divided into different groups based on reported ejaculation frequency.
Multivariate adjustments were made for potential confounding factors such as age, body mass index (BMI), alcohol consumption, and physical activity.
Additionally, sensitivity analyses excluded participants with sexual dysfunction to minimize bias from associated low ejaculation frequency.

l  Research Findings

The study found that higher ejaculation frequency (more than 21 times per month) was significantly associated with a lower risk of prostate cancer, particularly for low-risk prostate cancer.

For example:

• Men who reported higher ejaculation frequency in their 20s had a 19% lower risk of prostate cancer compared to those who ejaculated 4-7 times per month.
• Men in their 40s with higher ejaculation frequency had a 22% lower risk.

However, the study found no significant reduction in the incidence of high-risk or metastatic prostate cancer associated with ejaculation frequency.

In summary, the study supports the idea that frequent ejaculation might help reduce the risk of low-risk prostate cancer.

---

l  Can We Conclude That Ejaculating More Than 21 Times a Month Prevents Prostate Cancer?

 

The answer is “Not Yet!”

 

First, not all published research findings should be considered definitive conclusions.
A study is often published because of its significance, innovative methods, and potential for guiding future research.

In this case, the study was notable for its large sample size, long follow-up period, and rigorous statistical analysis.
However, it was an observational study based on self-reported questionnaires, which are prone to data bias.
The study aimed to identify associations, not establish cause and effect.

Moreover, since this was an observational study, it couldn’t entirely rule out the influence of unmeasured factors. Thus, a direct cause-and-effect conclusion cannot be drawn.

---

The Details Matter

According to the data:

• Men who ejaculated more than 21 times a month had about a 20% lower risk of developing low-risk prostate cancer compared to those who ejaculated 4-7 times per month.
• However, increased ejaculation frequency did not significantly reduce the risk of high-risk or metastatic prostate cancer.

Thus, whether frequent ejaculation truly offers protective effects against prostate cancer still requires more research.

---

l  How to Properly Prevent Prostate Cancer

First, understand the risk factors for prostate cancer, then adopt a comprehensive lifestyle approach, including:

• Quit smoking and limit alcohol consumption
• Maintain a healthy weight
• Exercise regularly
• Follow a balanced diet (See related articles for dietary advice).

---

l  Prostate Cancer Prevention Tips

1.    Healthy Lifestyle:
Maintaining healthy habits, such as a balanced diet, regular exercise, and avoiding smoking and excessive drinking, can reduce the risk of many cancers.

2.    Regular Check-ups:
Early detection and screening for prostate cancer, such as prostate-specific antigen (PSA) tests and digital rectal exams, are crucial, especially for high-risk men with a family history of the disease.

---

l Conclusion

While the study found that higher ejaculation frequency might be linked to a lower incidence of low-risk prostate cancer, it cannot be recommended as a prevention strategy.

Medical prevention efforts should focus on regular screening and a healthy lifestyle, not adjusting ejaculation frequency solely to prevent disease.

Understanding the relationship between ejaculation frequency and prostate cancer risk requires more extensive research. In the meantime, maintaining healthy habits and staying informed remain the best ways to reduce cancer risk.

References:

• PubMed Study on Ejaculation Frequency and Prostate Cancer Risk
• ScienceDirect Article

江湖傳言：一個月射精超過21次可以預防攝護腺癌是真的嗎？

「醫生，聽說一個月射精超過21次可以預防攝護腺癌，真的嗎？」

 

這樣的說法倒也非空穴來風

會有這樣的傳言

源自一篇哈佛大學於2016年發表在影響係數極高(Imact factor: 23.4)的歐洲泌尿科醫學會期刊

該研究為針對射精頻率與前列腺癌（攝護腺癌）風險的長期追蹤，

觀察了超過3萬名男性，

追蹤了18年之久。

 

那麼，這項研究到底發現了什麼？讓我們來仔細看看其中的科學依據。

 

l  研究方法

這項大型前瞻性研究使用「健康專業人員隨訪研究」(Health Professionals Follow-up Study, HPFS)中的數據，

研究的主要對象是31,925位美國男性健康專業人員，

於1992年報告了其平均每月射精頻率，

並在後續18年中進行追蹤至2010年。

參與者在三個年齡範圍（20-29歲、40-49歲及問卷發放前一年）報告其每月射精次數，

這些數據用於分析射精頻率和前列腺癌風險之間的關聯。

 

在數據分析方面，

研究使用了Cox比例風險模型估計射精頻率和前列腺癌發生率的風險比（HR）及95%置信區間（CI）。

根據報告的射精頻率，

參與者被分為不同組別，

並進行多變量調整分析以排除潛在混淆變數的影響，

如年齡、身體質量指數、飲酒、體力活動等。

此外，

研究也進行了靈敏度分析，

排除性功能障礙患者，

以避免因合併疾病導致的低射精頻率影響結果。

 

l  研究結論

研究結果顯示，

射精頻率較高（每月超過21次）與較低的攝護腺癌風險有顯著相關，

特別是在低風險攝護腺癌的發病風險中。

例如，

在20-29歲時射精頻率高的參與者的攝護腺癌發病風險比報告每月射精4-7次的參與者低19%；

在40-49歲時射精頻率高者的風險則降低22%。

 

研究還發現，

較高的射精頻率並不會顯著降低高風險或轉移性攝護腺癌的發生率，

因此，

總結而言，

這項研究提供了支持「頻繁射精可能有助於降低攝護腺癌風險」的證據。

 

 

l  所以，我們可以根據這篇論文，得出「一個月射精超過21次的確可以預防攝護腺癌」的結論嗎？

 

答案是「還不行」！

 

首先，

我們要了解，

並不是所有登在期刊的研究結論都可以被視為學術上的最終結論，

研究之所以被刊登，

很有可能是基於研究的重要性、創新性、嚴謹的研究方法、學術或臨床意義對後續研究有參考價值。

以這篇而言

黃醫師認為會被刊登的原因在於

它是學界少見如此大數量、長時間追蹤且用了嚴謹的統計方式去做的問卷調查研究

而問卷分析的觀察性研究

常有數據偏差的可能性

且此類研究主要目的為看是否能得到一些觀察性的結論

而不是確立明確的因果關係！

並且由於研究屬於觀察性研究，

無法完全排除其他未測量因素的影響，

因此不能得出直接的因果結論。

 

再來

魔鬼藏在細節中

根據研究的數據

每月射精超過21次的男性，

相較於每月射精4至7次的男性，

「低風險攝護腺癌」的發病率降低了約20%。

然而，

對於「較高風險的攝護腺癌」和「轉移性攝護腺癌」，

射精頻率的增加並未顯示出顯著的預防效果。

因此，

高頻率射精是否真有所謂的保護或降低罹癌之作用

可能還需要更多研究來探討。

 

l  那麼，該如何正確的預防射護腺癌？

 

首先，

我們要了解「攝護腺癌的危險因子」有哪些

然後採取「全面性的生活型態調整」

比如戒煙、戒酒、體重控制、運動、飲食

至於相關飲食建議

請參考「這篇」

 

l  預防攝護腺癌衛教建議

 

1. 健康生活方式：健康的生活習慣，如平衡飲食、規律運動、戒菸限酒，對維持整體健康和降低多種癌症風險均有幫助。

2. 定期檢查：攝護腺癌的早期檢測和篩查，如前列腺特異性抗原（PSA）檢測和肛門指診檢查，對高風險男性（如有家族病史者）尤為重要。

 

l  結語

總的來說，

雖然研究發現「高頻率射精可能與較低的低風險前列腺癌發生率有關」，

但無法作為預防攝護腺癌的建議方法。

醫學上的預防策略更應著重於定期篩查和健康生活方式，

射精頻率則應依個人需求和健康狀況調整，

而不是為了預防疾病而刻意改變。

 

希望這些信息能幫助大家正確看待射精頻率與前列腺癌的關聯性，

保持健康的生活習慣，

更有效的預防攝護腺癌。

 

References: 

https://pubmed.ncbi.nlm.nih.gov/27033442/#full-view-affiliation-1

 

https://www.sciencedirect.com/science/article/abs/pii/S1558767324000168

 

Risk Factors for Prostate Cancer

1.    Age
The risk of prostate cancer increases with age.

2.    Family History
Men with a family history of prostate cancer in male relatives have a higher risk of developing the disease.
Source

3.    Race
African-American men are at higher risk for prostate cancer.

4.    Genetic Factors
Over 100 genes have been identified as being associated with prostate cancer. The most common pathogenic genes are:

o   BRCA2 (4.5%)

o   CHEK2 (2.2%)

o   ATM (1.8%)

o   BRCA1 (1.1%)

5.    Metabolic Syndrome
Conditions like hypertension and a waist circumference ≥102 cm are significantly associated with an increased risk of prostate cancer.

6.    Obesity
Studies suggest that obesity may increase the mortality rate associated with prostate cancer.

7.    Dietary Factors
While current studies do not establish a causal relationship between specific dietary factors and prostate cancer, the American Urological Association (AUA) still formulates dietary recommendations based on past research. In addition, the European Association of Urology also lists the following research conclusions related to diet and prostate cancer for public reference.

o   Alcohol:
Both heavy drinking and complete abstinence have been associated with higher risks of prostate cancer and prostate cancer-specific mortality, with evidence suggesting a correlation with alcohol consumption levels.

o   Coffee:
Coffee consumption may reduce the risk of prostate cancer.

o   Dairy Products:
High protein intake from dairy has shown a weak correlation with increased prostate cancer risk.

o   Fat:
No significant association has been found between long-chain omega-3 polyunsaturated fatty acids and prostate cancer. However, a potential link may exist between fried food consumption and increased prostate cancer risk.

o   Tomatoes (Lycopene/Carotenoids):
Some studies suggest that consuming cooked tomatoes and lycopene may have a protective effect against prostate cancer. However, meta-analyses indicate that current evidence is insufficient to recommend lycopene for the prevention or treatment of prostate cancer or benign prostatic hyperplasia.
Source

o   Meat:
Meta-analyses show a potential association between the consumption of red meat, total meat, and processed meat with prostate cancer risk.

o   Soy (Phytoestrogens: Isoflavones/Coumarins):
A meta-analysis revealed that phytoestrogen intake is significantly associated with a reduced risk of prostate cancer. Soy food consumption has been linked to a lower risk of prostate cancer but is also associated with an increased risk of advanced disease.

o   Vitamin D:
A U-shaped relationship has been observed, with both low and high levels of vitamin D associated with an increased risk of prostate cancer, particularly in severe cases.

o   Vitamin E/Selenium:
Selenium levels in the blood (primarily in nails, indicating long-term levels) are inversely related to aggressive prostate cancer. However, supplementation with selenium and vitamin E does not appear to impact prostate cancer incidence.

8. Hormonally Active Medications

A. 5-α-Reductase Inhibitors (5-ARIs)

Although 5-α-reductase inhibitors (5-ARIs) appear to have the potential to prevent or delay the progression of prostate cancer (PCa) by reducing the risk of ISUP grade group 1 cancers by 25%, this benefit must be weighed against treatment-related side effects and the potential slight increase in the risk of high-grade prostate cancers (although this does not seem to affect PCa mortality).

Currently, none of the available 5-ARIs are approved by the European Medicines Agency (EMA) for chemoprevention purposes.

B. Testosterone

Men with hypogonadism receiving testosterone supplementation do not have an increased risk of developing PCa. A pooled analysis revealed that men with very low free testosterone levels (lowest 10%) have a below-average risk of PCa.

Furthermore, although evidence is limited, men undergoing expectant management or those who have received radical curative therapy for PCa do not show worse outcomes when receiving testosterone supplementation. This is despite the theoretical concern of increased progression risk following the correction of hypogonadism.

9. Other Potential Risk Factors

A. Inflammatory Bowel Disease (IBD):

Men with IBD have a significantly higher incidence of PCa (ISUP grade ≥ 2).

B. Baldness:

Associated with a higher risk of PCa-specific mortality.

C. Gonorrhea:

Significantly linked to an increased incidence of PCa.

D. Night Shift Work:

A meta-analysis shows that night shift work is associated with an increased risk of PCa.

E. Smoking:

Linked to increased PCa mortality, more aggressive tumor characteristics, and worse prognosis, even after smoking cessation.

F. Cadmium (Cd) Exposure:

A meta-analysis found a positive correlation between occupational exposure to high levels of cadmium and PCa risk (the exact risk magnitude remains unclear due to heterogeneity), whereas non-occupational exposure does not appear to pose the same risk, likely due to lower cadmium concentrations.

G. Human Papillomavirus Type 16 (HPV-16):

Men positive for HPV-16 may have a higher risk of PCa.

H. Plasma Concentration of the Estrogenic Insecticide Chlordecone:

Associated with an increased risk of PCa.

I. Factors Proven Incorrectly Associated with PCa Risk:

These include vasectomy and self-reported acne.

J. Aspirin and NSAID Use:

Conflicting data exists regarding their association with PCa risk and mortality.

K. Ultraviolet Radiation Exposure:

Associated with a reduced risk of PCa.

L. Circumcision:

A review found a small but protective association between circumcision and PCa risk.

M. Ejaculation Frequency:

Higher ejaculation frequency (≥21 times per month versus 4–7 times) is associated with a 20% reduction in PCa risk.

References: 

https://uroweb.org/guidelines/prostate-cancer/chapter/epidemiology-and-aetiology