The association between lower urinary tract symptoms and urinary tract infections, and subsequent prostate cancer workup: a nationwide population-based case-control study.

[BACKGROUND] We investigated how lower urinary tract symptoms (LUTS) and urinary tract infections (UTIs) affect prostate-specific antigen (PSA) testing and prostate cancer (PCa) workup. Furthermore, we examined the likelihood of high-grade PCa (Gleason score ≥7) and risk factors of high-grade PCa in men with LUTS/UTIs.

[METHODS] We identified all men having a first prostate biopsy in Denmark between 2010-2021 and matched with five age-matched controls without a biopsy. LUTS/UTIs was assessed in the year preceding biopsy based on diagnoses and prescriptions obtained from national health registers. Odds ratios (OR) were calculated using crude and multivariable logistic regression models.

[RESULTS] In 63,931 men with a first biopsy, 42% had LUTS/UTIs, compared to 16% of controls. For men with LUTS/UTIs the OR of biopsy was 4.30 (95% CI: 4.22-4.38) and 0.56 (95% CI: 0.54-0.58) for high-grade PCa at biopsy after adjustments, compared to men without LUTS/UTIs. The likelihood of high-grade PCa was significantly higher in men with increasing age, and a Charlson Comorbidity Index ≥2, but not with a known family history of PCa.

[CONCLUSION] PSA testing in men with LUTS/UTIs increases diagnostic PCa workup, but LUTS/UTIs are not associated with an increased likelihood of high-grade PCa at first biopsy.