Initially Dr. Myers responded to my "More Drama" entry as follows:
"While radiation induced neovascularization is the most likely cause, a polyp (early cancer) is possible. You need to see a urologist, and he will probably do a cystoscopy."
Shortly thereafter the participant in the internet cystitis discussion undergoing further screening to rule out bladder or kidney cancer reported the findings of his urologist as outlined below:
The cystoscopy revealed only dilated blood vessels in the bladder and prostate, resulting from the proton radiation he had in 2007. This is typical of radiation induced cystitis.
I relayed this information to Dr. Myers who modified his conclusion to: "So yours is almost certainly radiation induced bleeding that will disappear on its own."
As part of my research effort I asked Bob Marckini: "How common is proton radiation induced cystitis?" He replied, "While we have lots of members who have experienced rectal bleeding, we have far fewer who are experiencing hematuria. I would guess that over the past ten years, I've heard from a couple of dozen of our members with this condition. I am not aware of any case that hasn't resolved itself over time."
My research effort on this issue would be incomplete without contacting UFPTI. Accordingly by e-mail I asked my case manager how frequently their patients experienced hematuria. She discussed my inquiry with Dr. Gud E. Nuff and consulted her case manager counterparts . A summary of her telephone response appears below:
UFPTI patients report few cases of hematuria. Rare though it may be it typically occurs between two and four years post treatment and usually happens in conjunction with extreme exertion and/or dehydration.
The consensus of her in-house discussions was that an area of the bladder in close proximity to the prostate gland is radiated to the extent tissue damage results. Subsequent irritation causes sloughing off of new blood vessels in the area of healing. The technical term for this process is neovascularization. In most cases this condition resolves on its own without medical intervention.
As a tennis player I certainly over exert from time to time, and/on those occasions it is difficult to stay fully hydrated. Based on these deliberations I have decided to monitor this condition pending further development. If indicated I will discuss the matter with Dr, Myers at my next scheduled appointment on October 29, 2013.