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. 2026 Feb;134(3):486-492.
doi: 10.1038/s41416-025-03288-8. Epub 2025 Dec 3.

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

Jeppe Lyngbye Widding  1   2 , Hein Vincent Stroomberg  3   4 , Susanne Oksbjerg Dalton  5   6   7   8 , Klaus Brasso  3   6 , Andreas Røder  3   6 , Signe Benzon Larsen  3   5   9
Affiliations

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

Jeppe Lyngbye Widding et al. Br J Cancer. 2026 Feb.

Abstract

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.

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Conflict of interest statement

Competing interests: HVS has received travel expenses and speaking and lecture fees from MSD Denmark, and project support from Pfizer Denmark outside of the scope of this manuscript. KB has received speaker fees from Bayer Denmark outside the scope of this manuscript. AR has received project support from Bayer Denmark and Pfizer Denmark, prior speaker fee from Astellas Nordic, and advisory and consultancy for Pfizer, Amgen, MSD, Sanofi, Janssen, Astra-Zeneca, Recordati, Astellas, Bayer, Orion, Ferrin, Medtronic, and Intuitive outside of the scope of this manuscript. Ethics approval and consent to participate: The present study was performed in accordance with the Declaration of Helsinki. It was based on anonymized, centrally located Danish national register data, and approvals by relevant authorities have been obtained: Usage of DanProst by Danish Patient Safety Authority (Journal-nr.: 31-1521-330), creation and approval of the project at Statistic Denmark (Project nr.: 708122), and Danish Health Data Authority (Prescription Registry) (FEID-00005346).

References

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