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.