TOPLINE:

In a population-based study, patients with lower urinary tract symptoms (LUTS) or urinary tract infections (UTIs) were more than fourfold more likely to undergo prostate biopsy but showed 44% lower odds of having high-grade prostate cancer.

METHODOLOGY:

• Researchers conducted a nationwide population-based case-control study including 63,931 men (median age, 68 years) from the Danish Prostate Registry who had their first prostate biopsy between 2010 and 2021.
• Men with a first prostate biopsy were age matched with 317,515 men without prostate biopsy who served as control individuals from the general population of Denmark.
• Information on LUTS and UTIs in the year preceding the index date (the date of biopsy for the men with a first biopsy) was extracted on the basis of diagnoses and prescriptions from national health registers. Overall, 60% of patients had an index date between 2010 and 2015.
• Outcomes included the estimation of the likelihood of prostate biopsy and high-grade prostate cancer upon biopsy in patients with LUTS or UTIs.

TAKEAWAY:

• Overall, 42% of men with a first biopsy vs 16% of control individuals had LUTS or UTIs within the year before the index date. The likelihood of biopsy was more than fourfold higher in men with LUTS or UTIs after adjustment for age, calendar period, comorbidity, and a family history of prostate cancer (adjusted odds ratio [aOR], 4.30; 95% CI, 4.22-4.38).
• Men with LUTS or UTIs showed lower odds of high-grade prostate cancer at biopsy than those without LUTS or UTIs (aOR, 0.56; 95% CI, 0.54-0.58).
• Higher age (≥ 60 years) and high comorbidity (Charlson Comorbidity Index ≥ 2) were significant predictors of high-grade prostate cancer, and a family history of prostate cancer showed no significant association.
• Overall, 45% of men were diagnosed with high-grade prostate cancer at first biopsy; they were older (median age, 71 vs 66 years) but were less exposed to LUTS or UTIs during the preceding year of biopsy (36% vs 45%) than those diagnosed with benign or low-grade prostate cancer.

IN PRACTICE:

"LUTS/UTIs were associated with an increased likelihood of first prostate biopsy within one year despite that men with LUTS/UTIs were less likely to have high-grade PCa [prostate cancer] at biopsy," the authors wrote, adding that "LUTS/UTI are more likely signs of benign prostatic conditions or indolent PCa than high-grade PCa and should not solely guide PSA [prostate-specific antigen] testing."

"Clinicians may combine LUTS/UTI's, patients' age and comorbidities as a part of a risk-adapted individualized strategy for early detection of treatment-requiring PCa," they concluded.

SOURCE:

This study was led by Jeppe Lyngbye Widding, Urological Research Unit, Department of Urology, Copenhagen University Hospital — Rigshospitalet, Copenhagen, Denmark. It was published online on December 03, 2025, in the British Journal of Cancer.

LIMITATIONS:

This study did not include diagnostic MRI as an outcome of the diagnostic workup, although MRI before prostate biopsy was recommended for biopsy-naive men by European guidelines in 2019. Additionally, information was not available regarding digital rectal examinations, genes related to an increased risk for prostate cancer, potential symptoms of advanced prostate cancer, overweight or obesity status, and lifestyle factors, which could have been unevenly distributed between the two groups.

DISCLOSURES:

This study was funded by grants from the Danish Cancer Society Scientific Committee and Kirsten and Freddy Johansen's Foundation. Three authors reported receiving travel expenses, speaking fees, or project support from Pfizer Denmark, Bayer Denmark, and various other sources. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.