“But I had radiation for my prostate cancer over 5 years ago!” Blood and clots in the urine after radiation for prostate cancer.


“A diplomat is a man who always remembers a woman’s birthday but never remembers her age.” – Robert Frost

Of the top ten questions I have gotten over the years about misconceptions/misunderstandings of the various treatment of prostate cancer-the concept of the delayed effect of radiation on one’s body is one of the more common.

The typical situation will be the guy who has either had seeds or external radiation. He may have had a little bit of a bumpy go of it early on in the radiation, maybe some urinary symptoms of frequency or urgency or mild self-limited diarrhea, but then did well. That is until about 2-5 years later when he notes blood in his urine or exacerbation of the urinary symptoms again.

In the case of blood that is now visible in the urine and often times associated with clots, I’ll mention to the patient and  the wife that his is probably an effect of the radiation and the expected come back is, “But he had radiation five years ago.”

I’ll come back to my thoughts on that but first a note about clots because this is another thing that patients have trouble grasping and something I hear very frequently. Patients will spend an inordinate amount of time explaining clots, the color, how it felt to come out, what it looked like and so forth. This is because they feel that a clot makes the bleeding more significant. The truth of the mater is that a clot is simply blood that settled in the posterior aspect of the bladder then formed a clot. When the clot is voiding out it is compressed into “worm form” as it goes through the prostate and urethra. If you can void at all i.e. no obstructive problem because of the clot then it has no real clinical significance.

“I noticed blood at the tip of my penis after I pee’d red blood. And then a maroon looking gelatin thing came out shaped like a worm, a bunch of them, then there was more blood at the tip of my penis. Ever since then the color of my urine has been blood-red.”

  • You rarely lose enough blood in the urine to affect the blood count (it won’t make you anemic.)
  • Clots are the result of blood doing what it does, clot, and are molded like my old Mattel worm maker when I was young.
  • Think of a clot as a bouillon cube swishing around in the bladder discoloring the urine until it is gone. This is why a patient will say they had blood in the urine, passed a clot and then the urine cleared. The bleeding from the prostate or bladder as a result of the radiation probably stopped hours or days ago. So no active bleeding just the bouillon effect of the clot coloring the urine by dissolving slowly.
  • People on blood thinners, including low dose aspirin, are more at risk of bleeding secondary to the effect of radiation.

Radiation cystitis and for that matter radiation urethritis of the prostatic urethra is a given consequence of radiation. It is not a given however if a particular patient will have any symptoms related to it. The symptoms and clinical issues:

  • With seeds the vessels along the course of the inner channel of the prostate (the prostatic urethra) become very engorged and the vascularity of blood vessels increase. Visually they look like dilated vessels on a person’s nose if they have that disorder that Jimmy Durante had. In turn they become friable and easy to bleed.
  • Radiation cystitis is a term for the same process of the bladder mucosa. The normal vascularity of the inner lining of the bladder becomes more reddened, the vessels more prominent. In some cases the vessels in one spot change and in other patients the whole bladder is involved.
  • It usually progresses with time and is more common a year or two out rather than immediately.
  • This is why in my book I say “Do you want to pay me now…the immediate issues related to a prostatectomy” or ” Do you want to pay me later-the delayed side effects of radiation.”

What are some of the treatments or management of blood in the face of a past history of prostate cancer and radiation?

  • If the patient is on coumadin or aspirin and okay with the cardiologist it is best to stop those.
  • The hope is that it is one vessel and that stopping the meds and increased hydration that it stops on its own. This is a common scenario.
  • If the patient continues to have blood in the urine with or without clots, for the short-term as long as voiding is possible and no problems with being unable to empty the bladder, it is best in this case as well to pee patient, I mean be patient-ha. You can wait up to 7- 10 days if necessary. Again it usually have very little effect on the hemoglobin.
  • Bleeding, with clots and difficulty voiding is a bad case scenario because now the urologist has to do something to get the clots out, place a catheter and get things flowing again. He may or may not have to be fulgurated or treat a bleeding vessel which is the culprit.
  • Here’s how it plays out. The patient had seeds three years ago. He notices some blood in the urine. He calls his urologist-note he calls the urologist not the radiation oncologist and is advised to stop any blood thinners, increase water intake and be seen that day or the next. The patient begins passing clots and then in time he can’t void at all “clot urinary retention.” This occurs right after the doctor’s office closes. He calls the operator at the hospital who contacts the urologist and is advised to go to the emergency room.
  • By the time the patient gets to the ER he is in near excruciating pain because of the inability to urinate. The clots have clotted off the opening from the bladder to the prostate and as a result urine cannot flow.
  • There is a wait to get into a room at the ER however once in the room an IV is started and an attempt probably by one of the ER nursing staff who is good at putting catheters in.
  • If the patient has had a prostatectomy and then the radiation, there may be a narrowing at the bladder neck area, the area of the anastomosis, and this will not let the catheter get by and hence after several attempts and meeting no success, the patient may be given pain meds and the urologist is called and told ” We can’t get a catheter in. You need to come.”
  • If the nurse is able to get a catheter in then the clots are attempted to be irrigated free so that urine can flow into the catheter and in turn relieve the patient.  What normally happens is the irrigation of clots and release of urine and hence relief for the patient is piecemeal. By that I mean that a little urine will come out and then the clot obstructs the foley catheter. The nurse then irrigates the catheter in hopes to retrieve more clot and re-establish urine flow. This may or may not happen as  you can’t irrigate as well through a pliable tube such as a catheter as it collapses on itself and thwarts the process. Over time with the suction of clots, irrigation of the clots and often times having to take out a catheter filled with clot that won’t irrigate and reinserting another one hopes to achieve a free-flowing catheter with clots.
  • At this point if not already having done so, a three-way catheter is placed so there can be continuous irrigation of fluid to prevent the catheter from getting obstructed and prevent the formation of more clots hence restarting the whole process.
  • If a catheter can’t be passed or if catheter keeps being obstructed by clots then the patient often times is taken to the operating room by the urologist and under anesthesia places a rigid cystoscope that is of larger diameter than the catheter and doesn’t collapse on itself, to irrigate out all the clots, stop the bleeding point and then placing the largest three-way catheter as possible.
  • All the while this is a very painful drawn out process that can be associated with bladder spasms which have been alluded to many times on this site.
  • In time if the clots are all out, the bleeding stopped, the catheter can be removed after a few days and things then go back to normal. The patient still has radiation cystitis, is still at risk for bleeding in the future and if lucky the degree of cystitis stabilizes. It will not go away, but it may quieted down a bit and not progress.
  • Now there are things the surgeon did not mention if you had a robotic prostatectomy for sure…but I can see now the brochure and the ads on the internet of the radiation guy playing golf “a few days after the procedure.”
  • As I say in the book, “There ain’t no free ride.”

More on this later ….think hyperbaric O2 treatments.

49 Replies to ““But I had radiation for my prostate cancer over 5 years ago!” Blood and clots in the urine after radiation for prostate cancer.”

  1. my husband had prostate cancer about 5 yrs ago, had the radiation and all was well til just this past year then all H broke loose, the bleeding blood clots the blockage of the cathiter etc, this has happend now going on the 4th time.
    He has had the “turp” wouldn’t you know more bleeding and blood clots even
    after that my question to you, shouldn’t the patient be forwarned about these
    follow up problems? My husband oncologist was not even concerned he
    was having all these bleeding problems his coment YOU DO NOT HAVE
    CANCER THAT IS ALL I’M CONCERNED ABOUT The patient should be
    told down the road there will be bleeding blood clots etc I’m sure if he
    would have known he might have gone a different “route” now, he is told
    the prostate can not be removed because it has had radiation why is this?

    Any light you can put on this subject, will be greatly appreciated.

    A very concerned wife

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  2. Thanks for the info, I am a 64 year old male that had prostate cancer surgery 7 years ago an am going through the blood in my urine along with clots that are getting larger getting much harder to pass. Didn’t like the prognosis but now have an idea what the next steps could involve. Sounds pretty painful but there are things that can be done.

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    1. Hi , I have a friend who is currently going through the same situation as you Steve, he had a total prostectemy, followed by radiotherapy 7 years ago, he’s been in & out of hospital with reacurring blood & clots in his urine for the last 2 weeks; he’s been in lots of pain; he’s been on long term warfarin & im not sure if that’s all contributed to the blood clots, can you tell me if you were given any meds to help with the urine flow when you first had surgery? I feel that would have been better for my friend rather than long term warfarin, thanks.

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  3. yes im even worse i had radiation to the prostate 2yrs ago wasnt told of the awfull long term side effects,proctitus to the back passage,bleedng,i had the turps which was a fantastic sucess but the rest a total disaster at my health.im 85 now and very fit or was,now im fatigued tired,nauseus, no pain though im on balcalimide and ive stopped that ghastly zolodex injection frankly im sick and tired of the whole thing 6 years now,i wonder if i am one of those men diagnosed with p/c and never had it..i wonder i and others get the destinct feeling over a certain age,a few tablets clear off and with a bit of luck youll be gone soon our lousy consultants mine in particular he couldnt give a damn rsch guildford….,

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  4. This outline above is what has happened to my 87 year old dad right now allhas happened two bouts tobsurgery withen 3 weeks and now we are dealing with a healfhy man in a state of hospital delerium and no lessening of the bleeding 7 units of blood in 10 days now being told he may not be able to keep his bladder

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    1. My father-in-law, Pop, is 92 and is experiencing the same problem your dad has. What was the outcome? Pop has been told that he is too old for surgery. The Dr. has tried Amicar (which did not help) and now Alum.Hoping for good results, but not very optimistic.

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  5. I have had prostate cancer treated with radiotherapy etc .10 years later I suffered bleeding and clotting and blockages as described and have a catheter in now to clear the clots.This has happened 4-5 times in the last 2 years.I am 83 years old and love to hear potential solutions to the problem.

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  6. While you notice blood in urine (terminal), can exercise make it worse? Should you just hydrate well, and take it easy and hope it will stop? Thank you!

    Ps. I had brachytherapy and IMRT about 2 yrs ago.

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  7. Wow. I just stumbled across this post. Having my own issues with blood at the end of the urine stream. Had Cyber Knife 20 months ago. Minimal side effects other than difficulty urinating but now comes the blood. Had a cysto to discover the source. It appears to fragile blood vessels around the bladder neck. Uro also wants to use a ReviLix laser to reduce size of prostate to make urination easier. Trying to decide what to do.

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      1. Agree, but what alternatives are there? Meds like Tamsulosin and Finasteride help but still have some retention.

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      2. Thank you. This is why it can be difficult. Several websites suggest staying away from invasive procedures but it is the Uro. who is recommending the laser.

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  8. Someone I care about very much has been in the hospital for 2 months with blood clots. He had radiation for prostate cancer (not seeds) about 2 years ago. Over two months ago he began having difficulty urinating and blood clots were visible. In the ER they inserted a catheter, as you stated, and flushed out the clots that they thought were the problem and sent him home. This happened a few more times in the course of two weeks. They even sent him home with the catheter and flushing instructions. He was again brought to the ER and when a cat scan was done they found a huge clot “the size of a football”(their words) in his bladder they also found he had lost a considerable amount of blood and needed transfusions. They tried twice to remove some of the clot and close any holes without opening him up. They did continual irrigation. For some unexplained reason he gained 100 lbs. of water weight in the two weeks he was the hospital. Every part of his body was swollen. They finally had to open him up and insert a second catheter out the top of his bladder to alleviate pressure. At this time, they removed another large portion of the clot and repaired any visible holes. This was one month ago. He is still in the hospital on constant irrigation and we have now been informed that they had just been maintaining him. He is 69. They are now looking into transferring him to a teaching hospital. I would like to know if you have ever heard of this extreme a case.

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      1. Nancy,
        My dad is in the hospital with radiation cystitis. He has been bleeding for 3 weeks and has had two alum irrigations. Just today he had nephrostomy tubes placed to divert flow. He isn’t a candidate for hyperbaric treatment because he has hospital dementia. He’s had 9 units of blood transfused and is still anemic. Can you please tell me the progress of your father-in-law?

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  9. Wow. My Dad went through the same thing back in 2011. He was initially diagnosed with Prostate Cancer in 2002/3, so it was about 10 years until he started experiencing these clotting/bleeding issues. To treat it, he decided to undergo Radiation Therapy. However, In 2011, he noticed some blood in his urine. So his PCP referred him to the Network Urologist. Unfortunately, this first Urologist he went to performed some sort of an Endoscopic procedure and nicked my Dad’s Bladder or Prostate. It was after this that he started experiencing more issues with bleeding, clots, then multiple clots. This escalated to being unable to urinate and the subsequent ER visits. Visits with an (S). This caused an issue with clotting for about a month after that initial visit with the first Urologist. My Dad’s spirits were very low. He is an active Jehovah’s Witness and was unable to engage in his daily door to door ministry. As previously mentioned, he had to wear a catheter for about a month. Finally, with HBO treatment, the bleeding and the clotting eventually stopped. Our saving grace, was a very good Urologist at Thomas Jefferson Urology Associates and she was kind enough to explain the long term side effects of Radiation Therapy Treatment used to treat Prostate Cancer. She explained that whatever procedure was done by the first Urologist might have further irritated my Dad’s already weakened Prostate and caused it to bleed. She did stress that it didn’t cause it but might have irritated it. Unfortunately, it’s resurfaced again and we have an appointment with the same Urologist on Wednesday. But it’s nice to know that this is not an isolated long term effect. That other’s have experienced it. Great thread!! I’m glad I found it.

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  10. My Dad is having bleeding from radiation side effects of prostate cancer treatment. He had a procedure done (I am not sure what it was called) but he is still bleeding. They are suggesting if the bleeding does not stop he should have the Bariatric Oxygen treatment?? Anyone have any experience with this? He is 77 years old and VERY active.

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    1. I too have been having severe clotting in my urine ,some very hard to pass,I am going to the hospital this Friday for instituil [sp] therapy, where they irrigate my bladder with alum, I have had chemo and radiation treatments for my bladder cancer, although the cancer is gone after 7 years of fighting it, For the Bleeding, I had 44 treatments out of a recommended 60 of HBO, This caused my B/S to go down to the 40’s, and the last treatment,, I had a seizure and they took me to the hospital to be stableized, and the Dr. stopped the treatments, I have heard of those treatments helping, but, they didn’t do me any good ! My urologist seems to think if this alum stuff don’t work, he will have to remove my bladder.! Any advice appreciated ,and I am going to get a second opinion before removal !

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    2. My father had the bariatric treatment about five years ago and it was very effective in rejuvenating the cells in the lining of hi bladder. He experiencing allot less problems with bleeding and clotting. Unfortunately, the problems have resumed and he is in the hospital again. He already has two bags attached to his bladder and at 90 yrs old I don’t think he is a candidate for bladder removal surgery. It has been and continues to cause him severe pain when he needs irrigation treatments and the blood loss has given him anemia.

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  11. Is cystoscopy necessary.? Friend with Stage 4 Prostate cancer, had cryogenic freezing on prostate 4 yrs ago. Also had seeds implanted 2 yrs ago. He is seeing blood in urine and it’s painful lately. Dr not sure but recommends cystoscopy. Do we have any other less intrusive suggestions….since that could complicate more problems….infection, bleeding, etc…

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  12. Thank you so much for this post. I have been looking for answers to all of the above for my husband and am so glad I found the answers here. I sure wish we had been informed of these long term side effects when the decision to have radiation seed implants 11 years ago was made.

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  13. This reply is for the benefit of those looking for an answer. This answer for me was my salvation in November 2014. I had gross haematuria, clotting and retention for almost 12 months leading up to Nov 14. I was hospitalised on numerous occasions through emergency admittance throughout the year. Diagnosed with radiation cystitis for treatment to my prostate in 2012.

    I endured two TURP procedures, an alum wash, three sessions of green laser cauterisations and blood transfusions. Finally sent for a 3T parametric tesla MRI that identified a necrotic distended and ulcerated bladder that was breaking away and adding tissue to the blockages. also identified existing active cancer tumours that were in the remains of my prostate bed and bladder neck. The MRI was so good it graded the tumours and outlined enough detail to see that there was still a dividing line between the anus and the prostate gland that would allow salvage surgery to be attempted.

    My skilled urologist was able to carry out an eleven hour surgical procedure to remove the remains of the prostate, my bladder, my appendix and surrounding lymph nodes. he created a stoma for me which is a permanent fixture for urination purposes. While this sounds pretty drastic it has saved my life and I am in better health now than I have been for the past three years. My only penance is to maintain my stoma on a daily basis and deal with the odd leak at times.

    That has been my journey with this side effect of radiation treatment and while it has been the most serious and debilitating ride I have had with cancer treatment, I have been able to give my case as a positive outcome, for me at least

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  14. 55 years old. No cancer. But ongoing PSA (steady around 5.3-5.6) tests are crushing me. Knowing that it’s self-absorbed pitying makes me feel even worse. I can’t seem to shake off the shock and scare of the initial high PSA test.

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  15. John;

    Yes you may. Please do. I can’t seem to get past the initial elevated score, making me feel then like a broken down old man. My cousin (61) just died from the disease last year and we all know others who have been fighting it. Waiting 8 days for the results from the 2nd re-test, then 11 days for the negative result from the ultrasound crushed me. Steady, but still elevated test six months later hit me hard again, and a great score (4%) on a 4K test couldn’t bring me out of my funk. I feel ashamed that even though tests show NO, or INDOLENT prostate cancer at worst right now, can’t seem to make me happy. Waiting to retest (for the rest of my life?) in June.

    rich

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    1. Just a note to John, My friend had high psa levels for 8 years. They performed biopsy after biopsy never finding anything .. then the Dr. told him some people just have high psa levels. Eventually he ended up with a new Dr. who said “I know the cancer is there!” Well, persistence paid off. The cancer was found at the very anterior portion of the prostate covering the bladder and had had 8 years to grow and metastesize to his brain. If the PSA test is high continue checking in the rarest of rare places.

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  16. I have had the blood clots in my urine several times. One time I had to have the three way catheter put on. My best advice is to hydrate daily but really hydrate if the clots are there. You want to be able to void the clots. This all of urred about 5 years after my external beam radiation treatments for prostate cancer.

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  17. After reading all the problems many have had, in looking for an answer to my concern, I found that I am luckier than most. I had both EBRT and BT almost ten years ago. My only issue has been in a “weak stream” and “urine retention” if I don’t take my daily dose (0.4mg) of Flomax (more recently Tamsulosin). Just having turned 81, I am concerned about extended use of ANY medication. I recently stopped it, hoping I could “squeeze” byu without it but it seems unlikely. Luckily, never had/saw any blood clots for past ten years.

    Only two other medications I take are low dose (10mg) atorvastatin for elevated (105) LDL total 176 and based upon low risk factors plan to discontinue after little more than one year’s use. The other is Nexium for Acid Reflux that led to Barrett’s which has been under control for 15 years. Big concern about using it for so many years but discontinuing it for even a day, results in bad reflux. Taking supplements to reduce possible bone loss.

    Sorry for the extended history but it was to show my concern about ANY medication for extended periods and likely for the rest of my life. Is there something I could try in lieu of the Flomax. Even Saw Palmetto is likely to only address issues with BPH and not radiation damage. Any other find issues with atorvastatin use of extended periods? I can urinate weakly but concerned about potential bladder damage from retention. Thanks for any tips.

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    1. Hi,
      Have you considered Hyperbaric Oxygen Therapy(HBO)? It is non-invasive and has proven success for various effects of Radiation, such as Radiation cystis, radiation Proctitis and soft tissue injury (wounds caused by Radiation). The Official website for Radiation Cystitis as information. http://www.radiationcystitis.org/#!about_us/csgz . Local wound centers often offer HBO treatment. It is usually covered under your insurance. I work at a wound Center in Massachusetts and we have seem wonderful success.

      Shelly BSHCA, RN

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  18. My husband had radiation 12 years ago. He just spent a month in the hospital clearing it up, rehabbing his weak body and trying to get rid of delerium caused by intense pain. He, 80 years old, was home 4 days and bleeding started again and we are now into 4th day back in hospital. This time will be much quicker because of lessons learned on the first go around. I am hoping we can make it to hyperbaric chamber before another recurrance.

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  19. Can drinking alcohol, taking a turmeric supplement, or having sex, increase the chances of hematuria? Prostatectomy in 2009, radiation to prostate bed in 2012 , blood first seen 2015 and seems to increase after doing the things already mentioned. Should I stop drinking, taking turmeric, and stop having sex?

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  20. Recently diagnosed with Prostate Cancer, MRI report ” clinically significant cancer is highly likely to be present.” PSA 1.98, Cpa3 = 60, Dr. is recommending Cyber Knife. GPS (Genomic Prostate Score)Report – biopsy Sample too small for analysis. I am 70 years old, with enlarged prostate, 0.4mg Tamsulosin helps with flow. I am concerned about side effects of Cyberknife.
    Any feedback would be appreciated. Thanks in advance.

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  21. Greg Edwards,

    Fascinating article, and info, my P/C was diagnosed in 2008, at age 60 Gleason of 7, because of back issues we (wife & self) decided on external beam.. this failed, and we had subsequent seed implants in 2010, this also failed, and of course surgery was no longer an option, something we wish was a known before the radiation.. I responded well to hormonal therapy, but went CRPC six months ago, a bi lateral orcestomy (that broke the spell checker) was preformed three months ago.. oddly enough considering the cancers advancement, my PSA remains less than 1 (0.7) and my CT’s / PET scans, show no cancer anywhere in my body.. currently on a drug that shuts down the adrenal glands.. from the text of others I’ve managed the radiation pretty well, but am now seeing clotting in both urine and stools.. thank you Dr’s, and Patients, thoughts on where the tumor could be and if surgery is possible would be appreciated.. God bless

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  22. I was diagnosed with prostate cancer at the end of 2010 at the age of 72 and underwent ADT, TURP and External Radiation during 2011. Since the year 2015 (5 years later) I began to see a lot of blood and clots either at the beginning or at the end almost every time I urinated. The urologist gave me the same explanations found here regarding the problem as a delayed side effect of the Radiation and prescribed capsules with a compound formulation (BTW very expensive) and so far the episodes of gross bleeding at urination have turned less frequent, but have not disappeared and, in addition, all urine tests show the presence of blood. Fortunately so far I have been able to empty my bladder despite some large clots from time to time that make the urination difficult and very painful. That said, I have found all the cases and answers exposed in this thread very helpful and instructive for me to understand and confirm what’s the most likely reason for such worrisome symptom as well as what to expect and what could be necessary to do about it in the future.

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  23. good luck to all who have this horrid side effect of radiation. my husband has it and will now have his bladder removed. prostate cancer five years ago, then radiaton. enormous blood clots, so many blood transfusions we lost count, hemoglobin so low he was told he was nearing heart failure and still nothing was done except to give him blood and send him home to wait for the next blood clot he could not pass and wait in emergency for 3 hours to be seen. He has been hospitalized over 20 times for urine retention due to massive blood clots. finally after torturing him for five months they have come to the conclusion the bladder must be removed. He has been to hell and back with this. Prostate cancer was a walk in the park compared to radiation cystitis. There needs to be research done on this horrific side effect of radiation.

    he tried the HBOT with no results. I truly wish everyone with this side effect of radiation the best of luck, may your journey be better than the journey my husband has had.

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  24. Wow… 2012..Had EBR only + Lupron 12 months now bicalutamide all with good results. Now just started blood clots ( x2 in last 90 days) No pain no blockage. Dr M has really helped with this site, to understand what is going on. Just saw Uro and have set up C-scope in 30 days. Clots only lasted for 30 hours or so. I was sure it was a bladder issue altho GP texted me that he thought it was prostate issue. Oncologist told me to go to Uro. Now I am really wondering if C-Scope is a good idea. I don’t need any more problems at this point–no pain no blockage no blood. Stop all drugs except bicalutamide and simvastatin. Drink 100 gallons of water/day No soda. No booze. No sex ??. Re-read Dr E Emanuel (The Atlantic) ‘Why I hope to die at 75″ Seriously. What about lifting 35 lb weights and briskly walking 2 miles a day ? What about spicy foods ? Any comments gladly accepted And…Thank you Dr M….this was so good….will get book !!!!!!!!!!!!

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  25. I am 85 years old and had radio active seed implants about 15 years ago. My PSA went down to ,01 in about two months. The side effects were horrendous. Totally impotent, small urination every hour. totally sterile.If I feel like defecating I have about two minutes to get to the toilet or I am out of luck. Never had blood clots in my urine. But I have blood clots in both legs, the left one goes from my crotch to my foot. I have not been able to sleep for all of 15 years. I have sleep apnia? I also have bad balance problems and have frequent falls. In my opinion the seeds should have been removed after my PSA got down to 1 after a while. The doctors that did the operation said it will get better with time. It has got worse. I now have Parkinsons which may not be related to the implants. But if I had it all to do again I would have had the prostate removed. I am still alive, but life has not been a bed of roses for a very long time. Seed implants they can keep unless they are removed. You may say you 85 years old, but this has been going on for 15 years. My father was 96 when he died of lung cancer , being a heavy smoker for 80 years.

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