Family Concern - bleeding

[nat_allen4]

Hi all - Just a bit of background, my dad (52) was diagnosed with prostate cancer about two months ago, we have been assured it is a small slow growing cancer so he is going to have a few more tests and hopefully schedule surgery for after Christmas. Yesterday he went to the doctor as he'd had quite a bit of blood, the doctor told him he had nothing to worry about and is going to run a blood test next week and re check his PSA levels. Has anyone else experienced this? Or shed any light as to why docs don't seem concerned about this? Thank you.

[Hidden]

I don't have a lot of data on your father's condition, but I've never had a bleeding event.

I was diagnosed 17 month's ago with a Gleason 6, slow growing, with a few cores. At the moment, I'm under Active Surveillance. Has his Uro ruled that out? I'd be interested in the blood thing myself.

[Tall_Allen]

Men with a small, slow growing prostate cancer do not need treatment. They do need to be carefully monitored with a system called Active Surveillance. In the largest active surveillance rials in North America, over half the men still had no progression after 20 years.

The blood may be from a UTI, prostatitis, blood clots in bladder, or other benign causes. It is probably not from prostate cancer (which is usually asymptomatic until final stages).

[AlanMeyer Moderator]

Bleeding is really not a symptom of prostate cancer. I haven't heard people even with very extensive cancer with serious pain complain of bleeding.

If he has blood in his urine it sounds like a urinary tract infection, possibly associated with his biopsy or with some other problem like a kidney stone (which is nasty but not dangerous if treated and not hard to treat.) If he's bleeding from the rectum it might be a stomach problem or, conceivably but very unlikely if it started more than a month after his biopsy, an injury created by the biopsy. I'm sure there are other possible causes and I suggest seeing a primary care physician or urologist and getting a urinalysis or other tests to find out what's going on.

As far as his treatment is concerned, the two of you need to get a report of the biopsy and any blood tests done (PSA + any others). You particularly want to know the "Gleason score", the number of biopsy samples that contained cancer out of the total number of samples, and the amount of cancer found in each positive sample. If the PSA is less than 10, the combined Gleason score is less than 7, and the number of positive samples is no more than 2 out of 12 with perhaps up to 10% cancer in each, of if the cancer is a little worse than that but he is at an advanced age where he might not live more than 10 years anyway, then I think most doctors today would recommend "active surveillance". That means just get another PSA test every six months or so and get no treatment unless the PSA is going up. He should try to maintain a healthy weight and muscle tone - which is good for cancer as well as all the other things it's good for.

If the Gleason score looks good, it is also often recommended that the biopsy slides be sent out for a second opinion. Cancer pathology is a difficult art and pathologists don't always agree. In my case the first pathologist reported Gleason 3+3 but a later one at the National Cancer Institute where I enrolled in a clinical trial reported 4+3, which is significantly more aggressive. The NCI docs also did an MRI and discovered that my cancer had already penetrated outside the prostate capsule and thought that radiation was a better approach than surgery for dealing with it. A "multiparametric MRI" is becoming a standard diagnostic tool that can give more information about the nature of prostate cancer. Here's an article about it:

prostate.net/articles/using...

If your Dad decides on treatment, I do NOT recommend his getting surgery from just anyone who offers it. There is a significant difference between a general urologist who may perform a few or a half dozen radical prostatectomies a year and a specialist whose practice is mainly surgery for prostate cancer and who does 50, 100, or even up to 200 surgeries per year. It's like getting a root canal from your dentist - who is licensed to do them and has probably done some, or from an endodontist who does root canals all day long, has seen almost every variation of teeth and roots, and can do an efficient, practiced, professional job.

Also, if he decides on treatment, I recommend that he consult both a surgeon and a radiation oncologist. Radiation is generally easier to take than surgery and easier to recover from. It too has side effects, though they are mostly different from surgical side effects. Radiation too can go haywire and either fail to work or harm the patient, or both, if done incompetently. As with surgeons, it's very important to get a good radiation oncologist, one who treats a lot of prostate cancer patients and is more concerned with curing his patients than running more bodies through his shop to make more money.

I can think of three good ways to find a good surgeon and a good radiation oncologist:

1. Ask people you know, especially doctors.

2. Ask people on this and/or other support groups. If you say what city or state you live in, some others may know good doctors there.

3. Check out the National Cancer Institute's list of Designated Cancer Centers. These are mainly teaching and research centers where doctors are up-to-date with the latest and best techniques. See: cancer.gov/research/nci-rol...

I wish the best of luck to you and your Dad.

Alan

[Hidden]

An excellent summary from Alan.

Just to emphasise the point that is a small possibility that the bleeding is due to prostate cancer, but it is a very small possibility.

However, it does indicate something's wrong.

How much blood is there?.

Is it visible fresh blood I.e. red.

Is it visible only as cloudy (greyish) blood .

Or is it only detected by a urine test, not visible at all.

Obviously the more visible and the more red it is, the more worrying it is.

I had blood in my urine (not visible) for years due to Prostatitis. That's one extreme. I also have had more extensive visible red blood due to infection. That's another.

Also if it is serious in any way, there will probably be other symptoms e.g. a temperature or tiredness and breathlessness. There may be other indicators, does he take anticoagulants?

What worries a lay person and what worries a physician is different. If you're still worried you could perhaps ask your physician why they're not worried, then if you're still worried ask for further tests for haematuria.

[ng27868168]

First of all, I am not a doctor, nor am I an expert. Having said all that, I was diagnosed with PCa at age 52 just like you dad. I am NOW 78 AND STILL ALIVE. My PSA was 10.8 at time of diagnosis which included a positive biopsy. I decided, on the advice of my urologist as well as my General med Doc. to have the radical surgery to remove my prostate gland. At that time there was no robotic surgery, so open incision surgery was the only surgical option. I inquired about radiation instead of surgery, but both my urologist and Gen/Med Docs said radiation was an option but if the radiation did not kill all the cancer, later surgery was no longer an option as the prostate gland was no longer there enough to operate. Following my successful surgery I joined our local Prostate Cancer Support group and eventually became one of the facilitators, which really means nothing except over the last 22 years I have seen more than a few men who wasted time talking with too many Docs in hopes of finding the easiest "cure" and more than few of them died as a result of "watchful waiting" too long. At your dad's relatively younger age, the chances of him having a more aggressive type PCa is higher and his risk is greater. PCa is one of the most curable types of cancer IF, let me repeat, IF it is dealt with. Once it escapes the prostate gland and goes elsewhere, WHICH IT WILL, it is a whole much more dangerous and deadly disease. "watchful waiting" in my opinion is too often basically doing nothing until it is too late. "Active Surveilance" if done right is an option, but most men AND doctors who suggest it really don't pay attention enough until it is too late. Again, I am not an expert, Just my 22 years of surviving Prostate Cancer and watching others who have or had PCa. Good luck to your dad.

[dentaltwin]

Bleeding where--urine, semen, rectal?

Did he have a biopsy, and when?

[nat_allen4]

Thanks all for your replies. You’ve all made some fantastic points. Doctors aren’t concerned and as a lot of you have said seems to be something unrelated to the cancer. He has had appointments with a specialist urologist who offered him surgery and a laser treatment. Active surveillance was mentioned but recommended they test him again in six months and decide the best thing for him. The only reason they want to treat is because of his age, they say if he was any older they wouldn’t tend to treat as it’s so small and wouldn’t make an impact on his life. Thanks again for all of your comments.

[jackcop]

Hi!

Briefly, if there is blood in his urine, and he has just had a prostate biopsy done, I had blood in my urine for several days afterwards. Also, there are strong opinions here on this board so take that into account when researching prostate cancer.

jerry

[SergFL]

I had blood in semen and this is what triggered my visit to Uro. I never had it before and it scared me enough to see doctor. All he said it is common and there are 20-30 different causes for it to happen. One of them is PC (very low probability). This put me at ease. He also did DRE just to in case and found little firmness. Then all that stuff started...