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Urology/Prostatic Urethra Cancer


My husband (35 yrs old) has been having gross hematuria (blood clots) and hemospermia for the past 4 years. No other symptoms, no burning, no pain and there have been no injuries. The hemospermia happens about every 3 months and will take about a week for his semen to clear up. The gross hematuria happens less often but is always followed by hemospermia.
When he recently saw 5 rather large blood clots he went and had urinalysis, a PSA test, Pelvic MRI, CT of the abdomen and a cystoscopy with bladder flushing. All came back negative except the cystoscopy. The urologist reported - "Normal urethra up to the prostatic urethra where there is a 360 degree (except for the veru) papillary change in the mucosa which is certainly more marked than one would see normally even in an individual with inflammation"
He then suggested to biopsy 2 areas. He said if it shows benign inflammatory change then he would suggest a long course of antibiotics.
My husband has not had the biopsy but took a month of Doxycycline and on the final day of the antibiotics there was another gross hematuria (3 small clots). However the hemospermia after the hematuria was very faint when it is usually very visible.
How likely is this cancer in his prostatic urethra? Does cancer look like inflammtion? Can he just have inflammation without an infection? Can he have an infection or inflammation with no other symptoms? What could cause inflammation if there's no infection? (the antibiotics didn't work)
Thank you in advance for any help.

ANSWER: Carol:

Since I wasn't there and didn't see the images, it's very difficult to answer some of these questions.  Here is the best I can do from the available information.

An abnormal change in the surface of the prostatic urethra sufficient to make a urologist suspect a cancer is quite unusual and potentially dangerous.  Although such cancers are very rare, they can be quite aggressive so it's best not to take any chances.

Cancer of the prostatic urethra is quite rare so we'd have to say his chances of this are remote.

Cancer of the prostatic urethra can appear alot like inflammation.

It is possible to have inflammation without an infection.  Arthritis would be an example of this.

It is possible to have infections and inflammation with no clear symptoms.

Inflammation can be caused by infections from germs other than bacteria, irritation, mechanical trauma, prostate enlargement, prostatitis, etc.  He might need to take antibiotics longer or change them.  Without another cystoscopy, you have no way of knowing if the inflammation has changed.  You can't assume the treatment didn't work just because the hematospermia returned.  

My advice is to go back to the urologist and have another cystoscopy.  If the same suspicious findings are there, a small biopsy would settle the issue of cancer.

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for the prompt response.
I am concerned about your statement - "An abnormal change in the surface of the prostatic urethra sufficient to make a urologist suspect a cancer is quite unusual and potentially dangerous"
What do you mean by this? I'm not sure if this statement is good or bad.

Since this has been ongoing for 4 years would his symptoms have gotten worse or would he have other symptoms after all this time? (you did say prostatic urethral cancer is agressive?)

Thank you again for your help.


If a urologist has determined that the surface of the prostatic urethra is sufficient abnormal to recommend a biopsy, this indicates a high degree of concern and not doing a biopsy may open the door for a cancer to grow and spread.  For whatever reason, the patient has decided to ignore this advice. I am just pointing out that not following the recommendations of the urologist may have bad consequences.  This finding may have nothing at all to do with the hematospermia or any other symptoms.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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