Bleeding after Radiation for Prostate Cancer

Q:  Several years ago, I was in desperate need of your medical expertise and followed your advice to a healthier life. Today I write you because of my great fear concerning my husband's health. He is a 74-year-old retiree who underwent radiation eight years ago for prostate cancer.

Within the past few months, he has been urinating blood. Three different doctors concur that all tests were negative and that scar tissue from the radiation is the culprit. Bloody urine is very scary and we both live in fear of some deep-seated problem that eventually could be fatal.

Would we be justified in getting another opinion? Will the bleeding ever stop? I appreciate your help.

A:  In 1999, prostate cancer was the most common new cancer diagnosed in men, due mainly to increased PSA blood test screening. There is still a lot of controversy about how to treat it, especially in older men, because men over 75 will probably outlive their prostate cancer and die from something else.

Your husband was only 66 when he was diagnosed and you don't write about the stage or decisions involved, but unfortunately he is now dealing with complications this many years later. I have good news for you, though!

William A. See, MD, Professor and Chairman of Urology at the Medical College of Wisconsin, who has special interest and expertise in prostate cancer, told me that "late" bleeding is not uncommon and is a well-recognized risk of radiation therapy.

It can occur five, 10, or even 15 years after treatment and does not usually represent recurrence, as the other three physicians have already assured you. It is important to evaluate the bladder to see what cause can be found, such as urinary infection, scar tissue, or inflammation of blood vessels. Be sure that your husband isn't taking aspirin or anti-inflammatory drugs that could increase bleeding. For intractable bleeding, Dr. See says that being placed in a hyperbaric oxygen chamber has been somewhat effective.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.