Dear Dr. Motola,
I underwent brachytherapy and HDR treatments for advanced prostate cancer 16 months ago. This past week I've been experiencing off and on bleeding, with some clots, from the penis. I consulted both family doctor and urologist, but they indicated it was probably from my prostate and did not seem concerned. There is no UTI.
Is this a common occurrence? Should we have further testing done; i.e., scope or CT scan? Obviously, I am quite concerned and just trying to reassure myself that this is a possible side effect of the radiation. Thank you.
If you are experiencing hematuria (blood in urine), and especially passing clots in your urine, cystoscopy should definitely be considered. Secondary cancers of the urinary tract have been reported in patients after undergoing radiation therapy. Cystoscopy and an imaging study of the upper urinary tracts will probably be necessary. Talk to your doctor about this course of treatment.
You or your doctor may notice an abnormal hardening of the tissue below the skin, in one area along the shaft of the penis.
During erection, there may be:
A bend in the penis, which usually begins at the area where you feel the scar tissue or hardening
Narrowing of the penis
Problems with penetration or pain during intercourse
Shortening of the penis
Signs and tests
The health care provider can diagnose curvature of the penis with a physical examination. The hard plaques can be felt with or without an erection.
The doctor may use injected medications to cause an erection. Or you may provide your health care provider with pictures of the erect penis for evaluation.
An ultrasound may show the scar tissue in the penis, but it is not necessary.
When diet and health modifications have failed to alleviate erectile dysfunction and the patient has tried all forms of the oral medications , the patient must then be counseled on the remaining types of therapies, including the prostaglandin family of medications. These are medications that act locally in the penis to give an erection. This differs from the pill or " Viagra " type of medications that require the central nervous system (i.e., the brain) to tell them to work. This type of medication comes in two preparations and can be delivered in two routes (injection or penile suppository). The first route is by injection into the penis. The common brand name for this medicine is Caverject or alprostadil (generic). This medication also comes in various strengths as the pills do. A lot of patients do not like this option for obvious reasons. It does require the injection of the medicine into the base of the penis. The medication is dispensed in a small via...
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