to the editor: In their cautionary review of prostate cancer screening, Mulhem and colleagues did not mention a potentially life-threatening long-term complication of radiation treatment. Symptomatic hematuria occurs in 2.1% to 8.2% of patients treated with external beam radiation or brachytherapy.¹ The pathophysiology is chronic fibrosis and progressive endarteritis, which cause sloughing of the bladder mucosa and bleeding that may occur many years after treatment. These patients can suffer greatly from urinary frequency, dysuria, urgency, incontinence, blood clots, obstruction, catheterization, irrigation, cauterization, or transfusion. Radiation cystitis is one of the most common diseases I treat as medical director of a hospital-based hyperbaric medicine facility. A retrospective review of 60 patients who received an average of 33 hyperbaric oxygen therapy (HBOT) treatments showed that 80% of patients had total or partial resolution of hematuria. When HBOT was started within six months of hematuria onset, 96% had total or partial resolution of symptoms.¹ The treatment consists of breathing 100% oxygen in a single-place or multi-place pressure chamber at 2.4 atmospheres absolute for 90 minutes. Contraindications are few, and significant complications are rare, even in older patients. It is important for family physicians to know about the effectiveness of HBOT for soft tissue radionecrosis and for them to inform affected patients about this important treatment modality.

in reply: The main goal of our article was to review the current evidence for prostate cancer screening. We did mention common complications associated with treatment of prostate cancer. Because the focus of the article was screening, we did not focus in depth on the complications of treatment. Although HBOT is one of the many available treatments for hemorrhagic radiation cystitis, conservative management continues to be the best option.¹