BACKGROUND AND AIMS: The optimum investigation of haematospermia is unknown. The association of this condition in relation to pathology and in particular prostate cancer is controversial and there is a paucity of evidence based literature regarding the above. The aim of this study was to investigate haematospermia as a presenting symptom of significant underlying pathology and to assess the diagnostic value of routine urological investigations.METHODS: 300 consecutive patients referred from primary care to a tertiary urology referral centre presenting with haematospermia were included in this observational case series. Data on patient age, concurrent presenting symptoms and urological history were collected. Subsequent patient investigations and final diagnoses were recorded. PSA and digital rectal examination (DRE) findings were noted in the over 40 age group.RESULTS: Of 469 investigative episodes, comprising: 206 flexible cystoscopies, 232 renal ultrasounds, 16 intravenous urograms (IVUs) and 15 scrotal ultrasounds; only 2 (0.4%) resulted in findings of significant new pathology which required surgical intervention. 13 prostate cancers were detected (5.7%) and 2 of dysplasia, all in men over 40 years either with a PSA of >3.0 ng/dl or an abnormal DRE.CONCLUSIONS: PSA measurement and a DRE should be carried out in patients over the age of 40 years presenting with haematospermia to screen for prostate cancer. Investigation of haematospermia in the form of flexible cystoscopy, ultrasound or IVU has a very poor diagnostic yield and is not recommended routinely for an initial presentation of haematospermia.
Adolescent Adult