Investigation of patients with haematospermia – how common is an underlying diagnosis of cancer?

Satchi M1, Katelaris A2, Smekal M2, Alnajjar H2, Muneer A2,3,4
1Darent Valley Hospital, United Kingdom, 2Institute of Andrology, University College London Hospital, United Kingdom, 3NIHR Biomedical Research Centre, University College London Hospital, United Kingdom, 4Division of Surgery and Interventional Science, UCL, London, United Kingdom

Introduction:
Haematospermia, although often found to be a benign condition in the majority of patients, can be an alarming sign for both patients and doctors. Guidelines relating to the investigating haematospermia are limited. The aim of this study was to evaluate the incidence of an underlying pathology and the value of diagnostic investigations performed in patients presenting with haematospermia.

Patients and Methods:
A retrospective review of 393 consecutive men investigated for haematospermia was performed in a single centre. Patient demographics, radiological and microbiological results were all recorded together with the clinical outcomes.

Results:
In this cohort, the median age was 50 years (range 15-82 years). The overall prostate cancer detection rate was 5.3% but 7.2% in the ≥40 years group. Two further patients were diagnosed with testicular and bladder malignancy. A further 5.6% of patients were found to have a benign pathology suitable for intervention. 288 patients underwent a transrectal ultrasound scan (TRUSS) and 58.7% (n=169) of these patients were found to have a positive finding (total findings n =188). 110 patients underwent a multiparametric MRI and 73.6% (n=81) had a positive finding.

Conclusions:
This is the largest reported cohort of patients investigated for haematospermia. The overall cancer detection rate was 5.9%. Apart from TRUSS and MRI prostate, the remaining investigations have a low diagnostic yield. Based on these results, we propose an algorithm for the management of haematospermia to limit unnecessary investigations.