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Dr. B
Dr. B, Urologist
Category: Urology
Satisfied Customers: 62
Experience:  Trained in Adult and Pediatric Urology, Fellowship trained in Urologic Oncology.
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I am bleeding from my penis, after sex, and once this week

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I am bleeding from my penis, after sex, and once this week heavily when urinating. This began 4 months ago but has become much more severe in the past week. Take clopidogrel daily, aspirin every 3 days, but stopped these 4 days ago
Dr. B
If you are still having bleeding in the urine you need another full evaluation for this by your urologist. You do need another cystoscopy as well as imaging with CT scan to fully evaluate your kidneys and ureters. You should also have a urine culture and urine cytology test. If all these are negative then it is probable that the blood is coming from the prostate. A medication like Avodart or Proscar could help if this ends up being the problem. I hope this helps you.
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Customer: replied 6 years ago.
Thank you. If there is a problem with the prostate, what are the likely issues / problems? My local hospital said that in principle I should have a prostate biopsy, but they won't do this while I am taking the aspirin and clopidogrel. My angioplasty was in April, and I am on that medication (If I continue to take it) until April 2011 at the very least.

I am concerned that I may have a prostate problem which will have run for almost a year without being diagnosed.
If the problem is with the prostate this is likely benign prostatic bleeding from a delicate blood vessel. It is possibly but unlikely due to cancer. You PSA result history as well as prostate exam would be useful to know in order to give a more accurate opinion. What you have described above does not necessarily indicate that you need a prostate biopsy, but it does mean you need an evaluation for blood in the urine. They may have told you that you need a prostate biopsy for another reason, ie. an elevated PSA test or an abnormal digital rectal exam. I hope this helps.
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Customer: replied 6 years ago.

Thanks. My PSA results (I am in the UK, and I don't know if we use the same measures as in the US, where I assume you are) have been below 1.5 until the most recent. The last three were:

1.34 (March 2008)

1.18 (November 2009)

2.37 (September 2010).

So the benign prostatic bleeding would presumably be because of the aspirin / clopidogrel medication? And not reflect something urgent? Waiting times on the NHS in England can be quite long, and my doctors have not been treating this bleeding as serious (or at least as not urgent) but the recent sharp worsening in bleeding (more frequent, more profuse, deeper colour) has alarmed me, and I don't know if I should be paying to have faster, private treatment.

I would consider the bleeding a separate issue entirely from whether you need a biopsy based on these PSA values. You are still below the cut-off for age of 2.5. I do agree however that a biopsy may be warranted given that your PSA doubled in 1 year. Conversely you could have it re-checked in a couple months to make sure the most recent value wasn't just an aberrant one. If it is still above 2 then I agree a biopsy is warranted. But that issue is not urgent. The bleeding is separate and should be evaluated more promptly. Bladder cancer was be ruled out as a possibility and this takes significant precedence over prostate cancer screening. If you can't get a complete evaluation for the bleeding as I outlined above in the next several weeks, then you may want to consider what you've mentioned above. I hope this helps.
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