NEW ORLEANS—Urinary tract infection (UTI) may predict higher stage bladder cancer and greater mortality among older patients, according to a research presented at the American Urological Association 2015 annual meeting.

Additionally, UTI appears to delay the diagnosis of bladder cancer in both sexes, but more notably in women.

For the study, investigators led by Kyle A. Richards, MD, of the University of Wisconsin School of Medicine and Public Health examined Medicare claims data linked to the Surveillance, Epidemiology, and End Results (SEER) cancer registry. They identified Medicare patients older than 66 years diagnosed with bladder cancer during 2007–2009, who presented initially with either hematuria or UTI. 

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Researchers discovered that patients presenting with UTI were at the highest risk of adverse bladder cancer pathologic and oncologic outcomes compared to patients presenting with hematuria.  The odds of stage 2 or higher disease was 71% higher in men and 208% higher in women presenting with UTI. Likewise, bladder cancer-specific mortality was higher in men (50%) and women (37%) presenting with UTI. The chance of dying from any cause was similarly elevated by 39% to 47%.

When UTI claim was also considered as a presenting symptom in addition to hematuria,  time to diagnosis of bladder cancer was longer in women vs. men (72 vs. 59 days). Time to diagnosis, however, was not linked to worse pathology or mortality.  

“Symptoms of UTI in older patients might be a harbinger of bladder cancer and should prompt thorough evaluation if symptoms persist despite short-term conservative management,” Dr. Richards told Renal & Urology News. “Timely bladder cancer diagnosis and treatment may not always occur due to prolonged treatment for presumed UTI.”

According to the investigators, an alternate theory is that patients presenting with a true UTI might have different bladder tumor biology that leads to negative outcomes. Further studies may clarify the factors that lead to worse bladder cancer pathology and outcomes.