Abstract

Hematospermia is an alarming symptom and can cause significant patient distress, but work-up is often negative.To characterize the clinical evaluation of hematospermia and association with diagnosis of urologic malignancy.Using MarketScan® insurance claims database, we identified adult males 18 to 64 years old diagnosed with hematospermia from 2010- 2018. Benign hematospermia was defined as the absence of hematuria and elevated prostate specific antigen (PSA). Patients with a urologic cancer prior to diagnosis of hematospermia were excluded. We identified those who were diagnosed with a urologic malignancy.Annual average incidence rate of hematospermia was 56.6 per 100,000 (95% CI 55.4 - 57.8 per 100,000) in 2010 and increased to 73.6 per 100,000 (95% CI 71.7 - 75.4 per 100,000) in 2018. 56,157 patients presented with benign hematospermia. Most (57.5%) underwent at least one test, with the most common being urinalysis (51.7%), followed by PSA testing (11.9%). All other tests were performed in less than 3% of patients. 47 patients were diagnosed with a urologic cancer, including 28 with prostate cancer (0.05%), nine with testicular cancer (0.016%), six with prostate carcinoma in situ (0.01%), and four with bladder cancer (0.007%). Stratified by age, there was only one cancer diagnosis (testicular) in 15,106 patients under 40 (0.01%) and 46 cancer diagnoses in 40,611 patients 40 years old or above (0.11%). Median age of patients diagnosed with cancer was 56 (IQR 52 - 61).A small minority of patients with benign hematospermia were later diagnosed with urologic cancer in a large nationally representative sample. After excluding hematuria with urinalysis, physicians should conservatively manage and reassure patients with hematospermia especially those under 40 years of age. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/andr.13189

View details for PubMedID 35483126