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QUESTION: 75 yo w/m experienced first time large ejaculation of mostly blood 5 ml+. Normal ejaculations are very small amounts hypospermia 1.5 ml or less.Worried about PC and appreciate your comments.

Recent labs: Total PSA 3.4, % Free PSA 50.3. Highest previous PSA was 4.0. Meds; 20 mg Lipitor x 1. Very large prostate, measured approx 72 gms four yrs ago. Occasional mild burning sensation intermittent with urination. Episodes of frequent urination but not causing a problem. No nocturia.

Very large 7 cm cyst left kidney w small calcification. Urologist says not a worry (maybe not for him). Passed right kidney stone one  month ago. Horrendously painful trip to ER.

Other out of range labs: Fasting glucose 124;creatinine 1.31; eGFR 1.31; platelets 117; triglycerides 196; HDL chol 38;A1C 6.5; uric acid serum 9.3; apolipoprotein B 81.

Daily at home dipsticks don't indicate UT infection. Is there something that can be going on in the prostate that could a) not be a measurable infection; b) not be cancer and c)cause a frightening large ejaculation of blood never before experienced? Might antibiotics be indicated. I'm not clear on whether intraprostate infections are readily diagnosable with standard blood tests.

ANSWER: Tom:

Hematospermia or blood in the semen is scary but almost always totally benign and goes away by itself.  It's a little like a nosebleed.  

Your enlarged prostate might benefit from finasteride 5 mg daily to minimize further enlargement and possibly help with some of the urination issues.

We typically don't worry about cysts in the kidney as they rarely cause problems.

You might want to consider a 24 hour urine test to identify any chemical risk factors that might be causing your kidney stones.

There is no indication of any cancer.

A trial of antibiotics for a possible prostate infection is not unreasonable, but there is no blood test that will diagnose or confirm this.  It's strictly a clinical judgment call.

Now go talk to your urologist.



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

QUESTION: Hi Dr Leslie, I want to make sure I understand your points...

I understand that there MIGHT be infection within the prostate and it COULD be what caused the hematospermia. But no blood test exists that can confirm an infection within the prostate. However, a course of antibiotics CAN deal with such an infection (if there is one). If I've got that wrong -- and there's no correlation between hematospermia and infections -- please let me know. I didn't see any mention of the word "prostatitis." Does that mean we're not dealing with that particular condition?

What worries me most is the ratio of blood to semen. I've read accounts of semen tinged with blood. Mine was more like blood tinged with semen. If you didn't know it was ejaculate...well, you get the picture.  

My last question has to do with the % Free PSA score of 50.3 which is reassuring at higher PSA levels (so I've read). But does it have any significance when the total PSA is under 4.0?  Thanks so much.

Answer
Tom

You may or may not have.prostatitis. This cannot be determined from the information provided. Prostatitis is not usually associated with hematospermia. The degree of blood in the semen is actually not that important clinically as it does.not. change the treatment or indicate any more serious problem.

The free %PSA is not valid or reliable if the total PSA is less than 4.

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Stephen W. Leslie, MD

Expertise

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

Experience

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.

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

Publications
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.

Education/Credentials
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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