Burning and Blood with Ejaculation after Seed Implants
Dear OncoLink "Ask The Experts,"
My husband is 79 years old and had radiation seed implants three years ago for prostate cancer. His PSA's since then have been 0.9 or less. He continues to have blood in his semen and burning with ejaculation. Is this common this long after the implants? He's asked his oncologist and urologist, and they just say it's from radiation damage and offer no advice. Any information you could give us would be appreciated.
Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:
Yes, this can happen after a seed implant for prostate cancer. There is scarring in the prostate and scar tissue will contract as it matures, such that it may squeeze the veins in the prostate, causing the blood to back up into these tiny veins. With exercise like heavy lifting or jogging, the pressure increases and the veins may break. This will cause some men to have a drop or two of bloody fluid on their shorts, or a little blood when they initiate urination. The contraction of the pelvic muscles that occurs during sexual orgasm may also cause these veins to break. IMPORTANT: The breaking of these veins will not and should not cause severe bleeding, so if the bleeding becomes more than just a few drops, you should seek medical attention. This bleeding will not change blood counts. Blood in the prostate is irritating to the prostate, and so men may notice a burning or "itching" type pain in the base of the penis or in the perineum (that is the space between the testicles and the prostate). This is annoying, but again, there is no damage to tissues. An infection in the prostate may also cause these symptoms, and this should be ruled out the first time it happens. An infection may cause the prostate to be tender, and it may be associated with white blood cells in the urine and - occasionally - a positive urine culture. Most importantly, it may cause the PSA to rise a bit, but it is not from tumor and the PSA comes down if and when the infection is controlled. Hope this helps.