The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study

Abstract Purpose The carcinogenic effects of nitrate reduction to nitrite are well established, and nitrate has been closely linked to various diseases. However, research on its effects on the urinary system remains limited, and its association with PSA remains unclear. This study aims to investigat...

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Main Authors: Zhiyi Chen, Enpu Zhang, Lu Gan, Wenjuan Zhang, Guixiao Huang
Format: Article
Language:English
Published: BMC 2025-08-01
Series:BMC Urology
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Online Access:https://doi.org/10.1186/s12894-025-01878-5
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author Zhiyi Chen
Enpu Zhang
Lu Gan
Wenjuan Zhang
Guixiao Huang
author_facet Zhiyi Chen
Enpu Zhang
Lu Gan
Wenjuan Zhang
Guixiao Huang
author_sort Zhiyi Chen
collection DOAJ
description Abstract Purpose The carcinogenic effects of nitrate reduction to nitrite are well established, and nitrate has been closely linked to various diseases. However, research on its effects on the urinary system remains limited, and its association with PSA remains unclear. This study aims to investigate the relationship between urinary nitrate and PSA. Methods We employed weighted generalized linear models, weighted univariate analysis, forest plots, weighted multivariable analysis, and generalized additive models (GAM) to investigate the relationship between urinary nitrate and PSA. Subgroup analyses were conducted to further validate the stability of this association across different groups. GAM was utilized to provide a more intuitive representation of the specific relationships between PSA and urinary nitrate. Results TPSA, FPSA, and the prostate specific antigen ratio (%, 4 ng/mL ≤ TPSA ≤ 10 ng/mL) showed negative correlations with urinary nitrate. After adjusting for confounders, only the prostate-specific antigen ratio maintained a significant negative association (β = -632.7; 95% CI: -1094.9, -170.6; P = 0.011), while correlations with TPSA and FPSA were not statistically significant. A nonlinear relationship was observed, where urinary nitrate initially remained stable or changed minimally before gradually declining. Conclusion This study identifies a negative correlation between urinary nitrate and the prostate-specific antigen ratio in individuals with gray-zone TPSA. These findings enhance our understanding of urinary nitrate’s impact and may help reduce overtreatment in this population.
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spelling doaj-art-3b2f79a6ca1e4f5d871eafd31e2229bc2025-08-20T03:43:37ZengBMCBMC Urology1471-24902025-08-0125111110.1186/s12894-025-01878-5The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort studyZhiyi Chen0Enpu Zhang1Lu Gan2Wenjuan Zhang3Guixiao Huang4Department of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s HospitalDepartment of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s HospitalDepartment of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s HospitalDepartment of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s HospitalDepartment of Urology, The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People’s HospitalAbstract Purpose The carcinogenic effects of nitrate reduction to nitrite are well established, and nitrate has been closely linked to various diseases. However, research on its effects on the urinary system remains limited, and its association with PSA remains unclear. This study aims to investigate the relationship between urinary nitrate and PSA. Methods We employed weighted generalized linear models, weighted univariate analysis, forest plots, weighted multivariable analysis, and generalized additive models (GAM) to investigate the relationship between urinary nitrate and PSA. Subgroup analyses were conducted to further validate the stability of this association across different groups. GAM was utilized to provide a more intuitive representation of the specific relationships between PSA and urinary nitrate. Results TPSA, FPSA, and the prostate specific antigen ratio (%, 4 ng/mL ≤ TPSA ≤ 10 ng/mL) showed negative correlations with urinary nitrate. After adjusting for confounders, only the prostate-specific antigen ratio maintained a significant negative association (β = -632.7; 95% CI: -1094.9, -170.6; P = 0.011), while correlations with TPSA and FPSA were not statistically significant. A nonlinear relationship was observed, where urinary nitrate initially remained stable or changed minimally before gradually declining. Conclusion This study identifies a negative correlation between urinary nitrate and the prostate-specific antigen ratio in individuals with gray-zone TPSA. These findings enhance our understanding of urinary nitrate’s impact and may help reduce overtreatment in this population.https://doi.org/10.1186/s12894-025-01878-5PSAUrinary nitratePCaNHANES
spellingShingle Zhiyi Chen
Enpu Zhang
Lu Gan
Wenjuan Zhang
Guixiao Huang
The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
BMC Urology
PSA
Urinary nitrate
PCa
NHANES
title The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
title_full The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
title_fullStr The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
title_full_unstemmed The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
title_short The association between urinary nitrate and prostate specific antigen without prostatic disease: a cohort study
title_sort association between urinary nitrate and prostate specific antigen without prostatic disease a cohort study
topic PSA
Urinary nitrate
PCa
NHANES
url https://doi.org/10.1186/s12894-025-01878-5
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