External Beam RT and HDR Brachytherapy - my path

4½ years after RT, I found myself peeing blood. It wasn't fresh blood (not bright red) and it only happened once. I have some dip sticks at home and so next time I peed, I tested it, and although it looked fine, the dip test did show microscopic blood. Tested again next day, and no blood. Obviously, this is not unexpected after RT, but not having happened since the RT (and back then it was microscopic), it was a bit of a shock.

A few days later, I ejaculated for the first time since then, and stale blood in that just like after a biopsy (but not as bad), and has been for a week or so since, although it's become more diluted since. No more in urine. So it looks like the blood came from my prostate. It would be more worrying if it came from bladder or kidneys, but that doesn't seem to fit with the symptoms.

I'm due a oncology consultation in a month's time, so I'll mention it then.

Interestingly, 4½ years after RT is the peak incidence of late onset rectal bleeding. As you may recall, I've had that side effect since 5 months after RT, although minor and no impact on QoL, so it's never bothered me. Ironically, over the last few months, that's been diminishing and is now only happening about once a week (and so far this week, not at all).

Edited by member 05 Jan 2024 at 14:44  | Reason: Not specified

Thanks Dave, that does sound similar to my case.

I'm aware even a single incident of blood in urine should result in a 2WW, but I think I narrowed it down to the prostate rather than bladder or kidneys, which is not so worrying, or surprising, so I'll wait until my next oncology consultation as that should be in about a month. I'll be doing a PSA test before that, but will try to get things flushed out first so I can tell is it's still bleeding when I have the PSA test, which I guess might impact the result. Flushing things out is definitely not as effective as it was prior to treatment. I had that also with my second biopsy which was after I'd started HT, and couldn't really get the blood out of my prostate, and as a result, a blob of iron oxide (from the breakdown of the excessive blood) showed up brightly in my prostate when I had a full body MRI a few months later (shows up well because it's magnetic).

Edited by member 05 Jan 2024 at 14:40  | Reason: Not specified

My next 6-monthly PSA test has just come in at <0.03. It's been 0.04 for the previous couple of years during which I haven't been on HT, my Testosterone has been back (and rather high), and I still have a prostate. I'm surprised that 4½ years after external beam and HDR brachytherapy, it's gone down even further - I was expecting it to go up slightly, if anything. Actually, I think this change might be due to a change of lab test equipment or assay (chemicals the tests use), because the lab now measure down to 0.03, whereas it used to be 0.01, and <0.03 is not really significantly different from 0.04 I've been for a couple of years before.

Testosterone has gone up, from 20.9 nmol/L a year ago to 28.8 nmol/L, which is now above the normal range (25.7 max at my age). It doesn't seem to have had any bad effect on PSA though. It was above the max level 18 months ago too.

The peeing blood at Christmas is being investigated. Ultrasound scan was OK, but cystoscopy wasn't, probably due to still healing from a UTI, but it will be repeated in 4-6 weeks to check things again. I asked for another consultation with colorectal too, to talk more about minor rectal bleeding which I've had for 4 years now. It's not really causing me a any problem, but what do I do about bowel cancer screening (given I'm now at higher risk), and is there any other implication of this continuing indefinitely or something I should be doing?

Edited by member 22 Feb 2024 at 15:27  | Reason: Not specified

Great news Andy, I hope my outcome is as good as yours….and I can’t wait to get the old testo back🤞

Excellent 👍