George Burns made people smile when he said, “You can’t help getting older, but you don’t have to get old.” Who doesn’t love the idea of staying young at heart? But staying young in body is another matter.
For example, urinary tract infections (UTIs) like bladder infections are rare in men younger than 50, but the incidence of these maladies increases as men age. Although such infections are more common in women, one reason they start showing up in older men has to do with the prostate gland. In turn, men who begin to have repeat UTIs have a greater chance of developing prostate cancer.
Urinary tract basics
The urinary tract system has two components, upper and lower. The upper urinary tract consists of the kidneys (located roughly at the rear waistline) and ureters (tubes that carry urine from the kidneys into the bladder). The lower urinary tract in men includes the bladder, prostate gland and urethra (tube that carries urine out of the bladder, through the prostate, and out of the penis). There are different types of UTIs in men:
- Cystitis refers to an inflammation of the bladder, in most cases caused when upward moving bowel bacteria invades the bladder and begins to grow. Symptoms include frequent urination, difficult or painful urination, abdominal or lower back pain, and blood in urine. It is treated by antibiotics.
- Urethritis is also caused by bacteria, but in this case the urethra, not the bladder, is inflamed. Urination symptoms may be similar to those of cystitis. It is also treated by antibiotics.
- Prostatitis is an inflammation of the prostate gland that can be caused by a number of things. Most cases do not seem to be caused by bacteria, so antibiotics will not be helpful. However, if a cystitis or urethritis also infects the prostate gland, symptoms can be severe forms other UTI symptoms. If prostatitis is not diagnosed, treated and resolved, it can become chronic prostatitis, an inflammatory condition that has been linked to prostate cancer.
Bladder/urethra infections and prostate cancer
To return to the theme of aging, a common age-related condition is BPH, or benign prostatic hyperplasia. This is a normal gradual enlargement of the prostate gland that can constrict the urethra where it passes through the gland, making urination less efficient. As a result of inadequate emptying of the bladder, there is a greater chance of bacteria growing in pooled urine and causing a bladder infection (cystitis) or even urethritis.
A new study found that men who have repeat UTIs have a higher risk of prostate cancer than men without UTIs. Specifically, those who see a doctor more than 5 times in a year for bladder or urethra infections have a significantly greater chance of developing prostate cancer.[i] What makes this study compelling is the large number of cases that were included in a nationwide analysis: 9347 men with bladder infection and 4926 men with urethra infection were each matched with 4 men (based on age and a year of diagnosis) who had no UTI history. A study of this size presents strong evidence of an association between bladder or urethral infection and the onset of prostate cancer. Although the precise mechanisms are not known, infection creates inflammation, and chronic inflammation (repeat infections) are breeding grounds for cell mutations that can accumulate and spawn cancer cells.
The moral of the story
The most obvious conclusion is not to delay seeing a doctor at early signs of urinary infection. If simple lab tests confirm the presence of bacteria, get on antibiotics and stay on them until the full course of treatment is complete – even if symptoms clear up in the first few days. This is important, since surviving bacteria lead to strains that become more hardy and resistant to antibiotics.
One final thought: The Sperling Prostate Center provides excellent, authoritative multiparametric MRI of the prostate. A “picture” is worth a thousand lab tests, and Dr. Sperling and his staff are leaders in distinguishing prostate cancer from other prostate conditions such as prostatitis and BPH.
Don’t write off UTIs as just an annoying, embarrassing or inconvenient side effect of getting older. To paraphrase Smokey the Bear, the long and young-at-heart life you save may be your own.
[i] Fan CY, Huang WY, Lin KT, Lin CS et al. Lower urinary tract infection and subsequent risk of prostate cancer: a nationwide population-based cohort study. PLoS One, 2017 Jan 3;12(1):e0168254.