Blood in Your Urine: Why is it there and does it indicate prostate cancer?

Keith A. Waguespack, M.D.By: Keith A. Waguespack, M.D.

When going to the restroom one day, you notice that your urine looks a bit pink. You think it might be blood. What should you do? First, don’t panic. Blood in your urine, known medically as hematuria, does not necessarily indicate prostate cancer or a fatal disease. While you should not panic, you should see your doctor.

Two Types of Hematuria

There are two types of hematuria, gross (macroscopic) and microscopic. Microscopic hematuria means the red blood cells are present in so small of an amount that they can only be viewed through a microscope. The typical, healthy person excretes up to 85,000 red blood cells each day. Doctors, viewing a urine sample, look for a greater ratio than this in a urine specimen before diagnosing microscopic hematuria. Gross hematuria means that blood is visible to the human eye. Sometimes this can be seen as a pink, red or a cola color in the urine. At other times, blood clots will appear as speckles in the urine.

Causes of Hematuria

There are three groupings of causes for hematuria or the appearance of hematuria—internal causes, dietary causes, and medicinal causes.

Some internal causes include:

  • Kidney stones.
  • Urinary tract infections.
  • Blockage of the urinary tract.
  • Blood clotting disorder.
  • Injury to the urinary tract (wreck, athletics, fall, etc.).
  • Benign (BPH), or enlargement of the prostate
  • Chronic diseases such as diabetes, hypertension and sickle cell anemia.
  • Viral infections
  • Inflammation of the kidney, usually of unknown cause
  • AND Prostate, kidney, or bladder cancer

Sometimes the false appearance of hematuria is as innocuous as eating dark-colored foods. Some foods that can masquerade as blood in the urine include:

  • Rhubarb
  • Blueberries
  • Blackberries
  • Paprika
  • Beets
  • Fava beans
  • Artificial food colorings

In addition, certain medications may lead to hematuria, including but not limited to:

  • Rifampin
  • Nitrofurantoin
  • Sulfonamides
  • Metronidazole
  • Phenytoin
  • Prochlorperazine
  • Phenolphthalein
  • Quinine
  • Chloroquine
  • Phenazopyridine
  • Levodopa
  • Methyldopa
  • Adriamycin
  • Desferoxamine

Hematuria as a Prostate Cancer Indicator

Hematuria is not typically the leading symptom indicating prostate cancer. In fact, prostate cancer is often quite advanced before noticeable symptoms appear. While blood in your urine should not incite panic, it is important to see your doctor if you notice its presence. In a 2003 article published in the New England Journal of Medicine, it was found that urologic cancers (mainly of the bladder and prostate) are estimated to account for about 5 percent of cases of microscopic hematuria. (Microscopic Hematuria, Robert A. Cohen, M.D., and Robert S. Brown, M.D. N Engl J Med 2003; 348:2330-2338, June 5, 2003). Gross hematuria can also indicate the possibility of prostate cancer. It is important that all men receive regular checkups where a urine specimen is taken.

Testing When Blood is Found

Tests will be performed to determine the cause and presence of blood. These can include urinalysis, urine culture, urine cytology, genital exams, rectal exams, blood tests, and imaging of the upper part of the urinary tract, which typically includes a computed tomography (CT) or ultrasound. In addition, cystoscopy (inserting a flexible tube through the urethra to view the bladder) may be performed to directly visualize the lower part of the urinary tract. A Prostate-Specific Antigen (PSA) Test and Digital Rectal Exam (DRE), along with possible imaging, will be used to determine the need for a prostate biopsy.

Your USMD Prostate Cancer Center physicians are trained urological specialists that can help determine the presence and cause of any blood in your urine. They can also identify any possible tie to prostate cancer. If you see blood in your urine, please do not hesitate in calling your doctor to get tested.

Keith A. Waguespack, M.D.

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