Hematospermia is rarely related to genitourinary cancer: lessons learned from 15 years of experience with 342 cases

European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction

“…The symptom represents approximately 1-1.5% of all urological referrals and occurs in all age groups, with a mean age of 37 yr [199,200]. Several reasons of haemospermia have been acknowledged and can be classified into the following subcategories: idiopathic, congenital malformations, inflammation/infections, obstruction, malignancies (eg, genitourinary cancers: prostate and testis), vascular abnormalities, iatrogenic/trauma, and systemic causes (Supplementary Table 5) [201,202]. The risk of malignancy in patients presenting with haemospermia is approximately 3.5% (0-13.1%) [209,210].…”

“…As with other clinical conditions, a systematic clinical history and assessment to help identify the reason of haemospermia is undertaken. Although the differential diagnosis is extensive, most cases are caused by infections or other inflammatory processes [199,202]. A sexual history should be taken to identify those whose haemospermia may be as a consequence of a sexually transmitted disease.…”

Hematospermia is rarely associated with urologic malignancy: Analysis of United States claims data

“…3 patients with hematospermia and normal PSA were followed for a mean period of 83 months, and only one patient, who had persistent hematospermia, was diagnosed with cancer (bladder). 8 Efesoy et al 16 examined 342 patients who presented with hematospermia to determine the frequency of genitourinary cancer, which was detected in only 11 patients (3.2%). Eight patients above 40 years were diagnosed with prostate cancer, of which seven had elevated PSA and one patient had an abnormal digital rectal exam.…”

Magnetic resonance imaging compared to ultrasound as the preferred method for diagnosing intractable haematospermia

“…The prevalence of haematospermia among urology patients is 0.21% (342/161258), and intractable haematospermia only accounteds for 0.022% (36/161258) (Efesoy et al., 2020). Due to its rarity, clinicians are often confused about the approach to manage haematospermia.…”

“…If not, the decision to perform TSV should be made with caution, and the patient's basic clinical characteristics should be reassessed to judge whether the haematospermia has another aetiology, such as posterior urethral haemangioma; ejaculatory duct obstruction; urogenital malignant disorders including prostate, testicular, and seminal vesicle cancers; urogenital malformations; and bleeding disorders. (Efesoy et al., 2020; Fuse et al., 2011; Han et al., 2015; Mittal et al., 2016; Ren et al., 2020; Tian et al., 2018).…”