Benign prostatic hyperplasia and risk of urological cancers: a prospective cohort study based on the UK biobank

Benign prostatic hyperplasia (BPH) is considered a risk factor for certain urological cancers; however, current evidence remains ambiguous. This study aimed to assess the relationship between BPH and risk of urological cancers, including any potential causal connections.

Between 2006 and 2010, we identified 190,829 participants in the UK Biobank. We used the Cox proportional hazards regression model to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We balanced the covariate differences between the BPH and non-BPH groups using propensity score matching (PSM). We also performed a two-sample Mendelian randomization (MR) analysis to investigate the causal link between BPH and risks of urological cancers.

Participants with BPH had significantly higher risks of prostate cancer (PCa) (pre-PSM HR 1.28, 95% CI 1.20-1.36, n = 1,127 cases; post-PSM 1.30, 1.19-1.41), bladder cancer (BCa) (pre-PSM 1.49, 1.17-1.91, n = 79; post-PSM 1.92, 1.32-2.80) and renal cell carcinoma (RCC) (pre-PSM 1.29, 1.02-1.64, n = 79; post-PSM 1.41, 1.01-1.99) compared to non-BPH participants. MR analysis revealed that BPH has a positive causal effect on PCa (OR 1.002, 1.000-1.004) and BCa (OR 1.001, 1.000-1.002). This association between BPH and PCa or BCa is significantly moderated by age (P < 0.001), and is more pronounced in white individuals and those with sufficient physical activity.

This study revealed that people with BPH have a higher risk of PCa, RCC and BCa. There is a significant causal relationship between BPH and an increased risk of PCa and BCa.

Not applicable. This study is a prospective observational analysis based on the UK Biobank cohort (application number 135237) and did not involve any interventional procedures that would require clinical-trial registration.