Urinary Bleeding in Elderly Patients with Prostate Enlargement

Q: Urinary Bleeding in Elderly Patients with Prostate Enlargement

Hello： 1. <br>I would like to ask the doctor if it is possible that cancer cells have metastasized, or if there is a new cancer? --> A CT scan has been performed on the bladder, kidneys, and prostate, and the doctor indicated that there should not be any major issues with the kid

Benign Prostatic Hyperplasia (BPH)

Hello doctor, I am inquiring on behalf of my elderly family member.
My grandfather is currently in the advanced stage of stomach cancer.
He has undergone surgery and is now receiving chemotherapy.
A CT scan to check for metastasis showed no significant issues (he had his entire stomach and spleen removed, along with a small section of the small intestine).
Recently, he has been experiencing blood clots in his urine, but there is no visible blood in the urine.
He does not have any pain or discomfort.
He has benign prostatic hyperplasia and has experienced a decline in kidney function, which is being managed with medication.
1.
I would like to ask the doctor if it is possible that the cancer cells have metastasized or if there is a new cancer developing.
The kidney function has been monitored with blood tests, and the doctor mentioned there are no significant issues.
2.
I would also like to ask the doctor what we should check in urology.
Initially, when he was diagnosed with stomach cancer, all tests came back normal, but he had been losing weight and vomiting, which delayed the diagnosis for six months.

Jiahao, 80~89 year old female. Ask Date: 2021/12/13

Dr. Du Shixi reply Urology

Hello: 1.
I would like to ask the doctor if it is possible that cancer cells have metastasized, or if there is a new cancer? --> A CT scan has been performed on the bladder, kidneys, and prostate, and the doctor indicated that there should not be any major issues with the kidneys, as blood tests have consistently shown no significant problems.
2.
I would like to ask the doctor what we should check in urology.
Initially, when diagnosed with stomach cancer, all tests showed no issues, but I continued to lose weight and vomit, and it took six months for a diagnosis to be made.
--> If urination is still normal, we can discuss this with the physician during the follow-up visit and inquire about any potential effects of chemotherapy.
However, if there is persistent hematuria or difficulty urinating, especially with blood clots, it is important to seek urological care as soon as possible.
Wishing you good health.

Reply Date: 2021/12/13

More Info

Urinary bleeding in elderly patients, particularly those with prostate enlargement, can be a complex issue that requires careful evaluation. Given your grandfather's history of gastric cancer and current treatment, it is understandable to be concerned about the possibility of cancer recurrence or metastasis. However, there are several factors to consider regarding the urinary bleeding he is experiencing.

1. Prostate Enlargement and Urinary Symptoms: Benign prostatic hyperplasia (BPH), or prostate enlargement, is common in older men and can lead to various urinary symptoms, including difficulty urinating, increased frequency, and sometimes hematuria (blood in urine). The presence of blood clots in the urine could be attributed to irritation or trauma to the urinary tract, which can occur with BPH. The enlarged prostate can obstruct the urinary flow, leading to increased pressure and potential bleeding.

2. Potential Causes of Hematuria: While the concern for cancer metastasis is valid, especially given your grandfather's medical history, there are other potential causes of urinary bleeding that should be considered:
- Urinary Tract Infection (UTI): UTIs are common in elderly patients and can cause hematuria. Symptoms may not always be present, so a UTI could be a possibility even if he feels well.

- Bladder or Kidney Stones: Stones can irritate the urinary tract and lead to bleeding.

- Trauma or Injury: If there has been any recent trauma to the pelvic area, this could also result in bleeding.

- Vascular Issues: Conditions affecting blood vessels in the urinary tract can also lead to bleeding.

3. Cancer Considerations: Given your grandfather's history of gastric cancer, it is essential to rule out the possibility of metastasis. While it is less common for gastric cancer to metastasize to the urinary tract, it is not impossible. Additionally, the development of a new primary cancer, such as bladder cancer, should also be considered, especially in the context of his age and smoking history (if applicable).

4. Recommended Evaluations: It is advisable to consult a urologist for a thorough evaluation. The following tests may be recommended:
- Urinalysis: To check for signs of infection, blood, or other abnormalities.

- Urine Culture: To identify any bacterial infections.

- Imaging Studies: Such as an ultrasound or CT scan of the abdomen and pelvis to visualize the kidneys, bladder, and prostate.

- Cystoscopy: A procedure where a small camera is inserted into the bladder to directly visualize the urinary tract and check for tumors or other abnormalities.

5. Monitoring Kidney Function: Since you mentioned that your grandfather has declining kidney function, it is crucial to monitor this closely. Regular blood tests to assess kidney function (such as serum creatinine and blood urea nitrogen) should continue, as any urinary obstruction or infection can further impact kidney health.

In summary, while the presence of blood clots in the urine can be alarming, it is essential to approach this situation with a comprehensive evaluation. The combination of prostate enlargement, potential urinary tract issues, and the history of cancer necessitates a thorough investigation by a urologist. Early diagnosis and treatment are vital to managing any underlying conditions effectively.

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