Is Blood in the Urine or Semen a Sign of Prostate Cancer?

Reviewed by: HU Medical Review Board | Last reviewed: October 2017

Blood in the urine or semen can be a sign of prostate cancer. It can also develop as a result of common prostate cancer treatment options including radiotherapy. When a tumor develops in the prostate gland, it can grow large enough that it begins to press on the urethra (the tube that carries urine from the bladder and out of the body) or on other surrounding glands or blood vessels in and around the male reproductive system. When this happens, these structures can get blocked or irritated, causing blood to appear in urine or semen.

Typically, blood in urine or semen, especially when present in individuals under the age of 40, is an isolated event. In these cases, the problem usually resolves on its own and may not have any apparent cause. However, if you are over the age of 40, or if you frequently see blood in your urine or semen, you should consult your doctor immediately. Your doctor will ask you about your full medical history to try to find any other potential causes of the blood, including sources of inflammation or infection like sexually transmitted disease (STD) exposure, or problems with your kidneys or liver.

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Causes of blood in urine or semen

Blood in the semen (also called hematospermia) or urine (hematuria) can also be caused by recent treatment for a urinary problem, injury to the testicles or other area of the male reproductive system, or obstruction due to benign prostatic hyperplasia (BPH). BPH is the normal enlargement of the prostate gland that comes with age. It can also be caused by blood vessel damage or benign growths called polyps.

If you’re at risk for prostate cancer or of the appropriate age to begin screening, your doctor may recommend prostate cancer screening tests such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE). If needed, ultrasounds, CT scans, or other imaging techniques may be ordered to get a better view of your prostate as well as your urinary and reproductive systems.1,2

How prostate cancer treatment can cause it

Blood in the urine or semen can also occur after prostate cancer treatment, especially after radiotherapy (including external beam radiation therapy and brachytherapy). After radiotherapy, radiation cystitis and chronic urinary retention can occur. Both of these conditions can cause irritation of the bladder, which can lead to blood in the urine. Radiation therapy can also damage nearby structures, causing blood in the semen.

Treatment options for blood in urine or semen

As mentioned previously, seeing blood in urine or semen may be an isolated incident that resolves on its own. However, if it’s a recurrent problem as a result of a prostate cancer tumor, the symptoms may subside after surgical removal of the tumor or other treatment to shrink the cancer. If blood in the urine or semen is a result of treatment, it will often subside within weeks or months of treatment. If this issue persists, it can often be treated by determining the underlying cause of the blood. Outside of typical prostate cancer treatment, treatment options for blood in the urine or semen include:

  • Antibiotics for infection of the bladder or reproductive tract
  • Anti-inflammatory medications
  • Surgery to widen the urethra
  • Bladder washes
  • Treating another underlying cause including kidney or liver issues, or BPH33,4