Post Radiation Therapy - Blood in Urine

My experience has been very similar to that posted by hector13. I had robotic surgery to remove a malignant prostate in 2007 (age 62) but my PSA started to rise again in 2018. I had 39 radiation sessions in 2018 focused on the area where prostate was removed which reduced PSA from 0.13 to 0.01 to 0.03 range where it remained the last time it was checked in early 2025. In May 2024, six years after radiation I started periodically seeing blood and small clots in urine. Sometimes it would be months between episodes. On one episode (while on Eliquis) a large blood clot plugged my urethra requiring an emergency room visit and a foley catheter to clear the blockage. My urologist did a cystoscope to check the bladder and found no issues. He said that it was probably from some damage to my urethra and offered no resolution. Now about 18 months after it started, I still have periodic relatively small amounts of blood in the urine and sometimes will pass clots. The latest was a relatively large clot that passed today after months of all clear. I'm wondering whether excessive straining or exercise might be a trigger.

I had 32 Proton treatments in 2016. The RO would ask me if I was having any blood in urine or stool. Just 3 months ago passed the stringy red clot in my Primaries office and sent to lab with no real read other than blood in urine. It has happened twice since then. I probably do not help things in that I ride, row, Peloton machines, I lift , and Ruck. So far I pass the blood and stringy mess and my next urine is clean...All kidney test are normal and I am regularly scanned because of stage 4 mCRPC.. I have no pain so I just move on.....

Hello. I am a RN and I am answering for my husband. He was diagnosed with Prostate CA in 2009 and received Proton therapy. Everything went peachy until 2017 when he had profuse bladder bleeding as a consequence of the radiation. He was diagnosed with Radiation cystitis. He remained in the hospital for several days having bladder ablation and a TURP. Since he kept bleeding the urologists ordered Hyperbaric Oxygen. He got 80 treatments and bleeding stopped….Until now in 2024 when bleeding episodes have started again. The urologists in Mayo Clinic said that the symptoms come and go. There are many options offered to stop it and surgery was brought in the conversation to remove bladder. My husband is 82 yrs, diagnosed with Amyloidosis that has affected his heart resulting in Right Side Heart Failure. Surgery is a risk at that age. No Oncologists in Proton therapy institute told any patient that Proton therapy could cause Radiation cystitis and even rectal bleeding. Znd probably they are not telling them either today. When my husband had that bleeding crisis in 2017 I called Proton Therapy institute and spoke with one of their oncologists, Dr Mendelhall, and she told me that they were starting to see many patients with prostate cancer who had finished treatment years ago with the same bleeding issue. She was the one who recommended Hyperbaric Oxygen treatment for my husband. That is the treatment they are recommending for Radiation Cystitis crisis. Hope this helps.

@hector13 and others, here are some relevant related discussions:
- bleeding after radiation
https://connect.mayoclinic.org/discussion/bleeding-after-radiation/
- Anyone been diagnosed with Radiation Proctitis?
https://connect.mayoclinic.org/discussion/radiation-proctitis/
- Looking for tips on managing Radiation-induced proctitis
https://connect.mayoclinic.org/discussion/radiation-induced-proctitis/

I will add that as you push and strain to get these “pieces of bladder” to pass, the urine in the bladder produces stones that are much more painful to pass, hence my cathing so much. You haven’t mentioned a cystoscopy, my Urologist’s had to use lasers to break up the stones. My previous Dr wanted to go ahead and bypass the bladder and where the bag, at my age I’m not ready for that, so I keep going with the path I’m on. I will say that the Suprapubic catheter allowed my bladder to heal to the point that the last two scopes found no stones. I keep hoping, but we’ll see. Again good luck

12 months after I completed 20 rounds of radiation, I came down suddenly one day with proctitis, passing blood and mucous through rectum. Doc gave me an enema and the symptoms eased off in a week.

I am updating my original post for this topic. I think it is an important issue that the administrator for the site should consider for one of the monthly Zoom briefings. When we are asked to consider radiation treatment, we hope it will kill all the prostate cancer and effectively cure our cancer. Often, this is not the case. Not only does the prostate cancer return, the radiation damages our bodies in different ways for years to come. Are the radiation centers actively working on procedures to better protect vital organs during radiation treatments?
Having said that, in my particular case several months after completing radiation therapy I experienced significant bleeding when I urinated (which caused a lot of discomfort) as well as when I had bowel movements. My bladder and rectum had been scarred by radiation. I was fortunate that I was quickly approved for oxygen therapy; there was a wound center about 10 minutes from my house with four hyperbaric oxygen chambers. I had 40 sessions with pure oxygen which eventually stopped all symptoms of bleeding. Oxygen therapy is very expensive; my insurance covered most of it, but I had to pay the rest. The other drawback pertains to vision. The doctor in charge of the wound center advised me that my vision would be negatively affected and he was right. I had to wait 6 months to get my prescription glasses changed.
So back to my current issue, On Monday this week during urination I passed a large solid item about 1/3 inches long. I believe it was a piece of my bladder that was the cause of my bleeding for several days, and ever since it passed the blood in the urine has stopped. I think this may be the pattern of radiation cystitus, that once the damaged bladder loses a piece, it produces bleeding in the urine until it is able to pass. I hope this never happens again, but if it does, I will have a better understanding of what is causing it.
If any other men have had periodic bleeding that ends upon passing solid matter, I would be interested in hearing your experience. Of particular interest are cases where a number of years has passed before any bleeding occurs following radiation therapy. For me it happened 5 years after my radiation treatment ended.
I would welcome any negative experiences of what you fellows have gone through after radiation therapy. This is an important topic.

Cystitis post proton therapy for prostate cancer. Severe cystitis, initially with pain and urgency. Improved after 60 HBOT sessions but intermittent bleeding continued. Serious bleeding last april resulted in 16 d in hospital(10 in St Elsewhere, 6 in St Mary’s). Two procedures, 4 transfusions, bleeding finally stopped after second procedure. In may-June another 20 sessions of hyperbaric O2. Still have occasional bleeding and just completed second stage surgery to place a neurostimulation device. The device won’t help the bladder vasculopathy but hopefully will reduce the daily number of self-catheterizations and associated trauma to bladder(neurogenic bladder related to a stroke not radiation). So, like sansman, radiation therapy is an appropriate decision but, like RP, can have complications. Good luck, don’t give up..

Sad to say that I am one of those low percentage people.
Diagnosed in 2016, RP in late 2017
30 radiation treatments in early 2018. Everything great for about 16 months.
Started passing blood mid 2019, and then I began what appeared to be chunks of bladder.
Urologist suggested HBO after
scoping my bladder and saying “it looks like a dog has been gnawing on it.”
After doing research on what little information there was on the HBO at the time other than it was going to take 4-5 hours a day so I changed Urologist and started “bladder installations” for the next 3 months, no improvement, so I changed Urologist again.
Oncologist noticed that there were spots in my hip that lit up during a PET-CT scan and put me on chemo pills that I was unable to continue due to the side effects.
Feeling there was no other options I had a orchiectomy done in July of 2021.
Started to self catheterize after a couple of trips to the ER. November of 2021, cathed 116 times, December was 121 times, January of 2022 it was 136 times, starting to see a trend here?
June of 2022 had the Supra public tube installed, spent the 4th and 5th of July in the ER because it blocked and then it finally started calming down, but getting it changed every month was inconvenient and the bladder spasms would bring me to my knees.
April of 2023 had it removed, back to self cathing but only 10 to 15 times a month and less after the periodic cystoscopies.
Now since I don’t produce testosterone I had to start taking estrogen blockers.
Don’t mean to frighten or upset you but like I said I’m one of those 1-2 % that’s had it rough.
I will tell you that if I would have known about this website 7 years ago some of my decisions might have been different.
It started when I was 57 and it still goes on today.
Keep your head up and go onward through the fog.
Good luck, God Bless

It wasn't offered. Our local hyperbaric chamber has been out of operation since 2021. We did at home sucralfate enemas twice a day for about 10 weeks. The bleeding stopped early on but after 6 weeks a follow up scope showed the ulcer wasn't quite healed so we continued for another month.