Q: My husband, who is 15 years older than me at 78 years, had surgery and radiation for prostate cancer 10 years ago. Recently he noticed blood in the urine, enough to make the water in the toilet bowl bright red. At first we thought that the cancer had recurred, but the doctor said it was unlikely to be the prostate because the PSA levels are low. We are waiting to see a specialist and the blood has now cleared up. What else do you think it might be? Is it serious?
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A: There are several reasons for having blood in the urine other than prostate cancer. The least dangerous and most likely cause is a urinary tract infection. This can be determined by a microscopic examination of the urine in the laboratory or doctor’s office.
If this is not the problem, I suspect there is more to it in your husband’s case or he would not have been referred to a urologist. He will probably order more tests such as an ultrasound of the kidneys and urinary tract and if necessary, proceed to do a cystoscopy.
This means putting a catheter with a light on the end into the bladder to look around inside. Your husband will be sedated for this procedure.
You mentioned that your husband had received radiation therapy in the past. This can sometimes lead to bleeding at a later date, but I think this is unlikely to happen so many years after the treatment. More likely causes are bladder tumours. These would be unrelated to the prostate cancer and are often treatable. Renal calculi, otherwise know as kidney stones, are another possible cause of blood in the urine. Surgical removal of the stone or complete removal of a kidney may be required.
You do not mention if your husband is taking medications. Non-steroidal anti-inflammatory drugs are common treatments for arthritis and may lead to thinning of the blood and abnormal bleeding in various parts of the body. Similarly, anticoagulant therapy may increase the chance of blood in the urine, but there still might be an underlying disease condition. Both these types of drugs are more likely to provoke rather than cause the appearance of blood.
There are other rarer causes, such as renal cancer, tuberculosis or parasitic infection.
Don’t forget that eating beets can cause the urine to look red.
Cause of aneurysms
Q: What causes brain aneurysms? My sister has one that is going to be removed with brain surgery. Is it hereditary? Should I be concerned?
A: There is a small degree of inheritance with aneurysms. As many as 20 percent of people who have suffered bleeding from an aneurysm have a close relative who has had one.
Certain rare medical conditions lead to an increased likelihood of getting a brain aneurysm. These are polycystic kidney disease, neurofibromatosis, Marfan syndrome and Ehlers-Danlos syndrome. The latter two are inherited disorders of connective tissue, which leads to easily stretched skin and tissue that is more likely to become damaged and break.
If you are worried, consult a neurologist who can order a CT scan or MRI of the brain to determine if you have any aneurysms. Cerebral angiography may also be required. It is better to catch cerebral aneurysms and surgically remove them before they rupture and bleed into the brain. Some may be small and
unlikely to rupture and can be left alone.
New research out of Berkeley University in the United States suggests that if women were exposed to DDT before the age of 20, they could be five times more likely to get breast cancer later in life. After exposure, the substance is stored in the fat cells for years.
DDT was used throughout the U.S. and Canada to get rid of mosquitoes. This practice began in 1945, peaked in 1959 and was banned altogether in 1972, because DDT was building up in the environment and harming birds and insects.
Although we did not have a lot of mosquitoes in England, I remember my father spraying the living room to get rid of houseflies with one of those big old-fashioned pump sprays.
He used to tell me to hold my breath while he was spraying, but of course the DDT would cling to furniture and carpets for days.
Fortunately, I am healthy so far, but the Berkeley study could explain why there is such a big increase in breast cancer in the baby boomer generation. Two-thirds of women diagnosed with invasive breast cancer are older than 55.
Earlier studies have not shown any significant relationship between pesticides and breast cancer, so the Berkeley findings need to be validated by more extensive research.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
