Brown semen often not a concern

Dear Dr. Roach: Iaman 85-year-old male. Other than being a Type 2 diabetic, I am still active and in good health. I do have a concern; on the rare occasions when I do ejaculate, the small amount of semen that comes out is brown. When I told this to my urologist, he said that it isn’t a problem.

However, when I checked online, I found a bunch of very scary causes. I am now worried that my doctor was just trying to reassure me. Because of my age, maybe he doesn’t think it matters. Your thoughts on this would be appreciated. T.M.

Answer: Red or brown semen is due to the presence of blood. I hear this once or twice a year from my patients, who are understandably very concerned. But fortunately, it usually isn’t due to any worrisome cause.

In fact, in my younger patients, if a history review, exam and urine test are all OK, I can reassure them with high confidence. In an older man, especially with diabetes, it is possible that there is an infection in one of the glands and ducts. A urine culture might be prudent in this case. However, one might argue that in absence of symptoms beyond what you have, treatment may not be necessary.

In a man in his 80s with persistent symptoms, the likelihood of this being something more serious is higher, but still relatively low. Some experts recommend imaging, such as an ultrasound or an MRI, to try to identify the cause. The big concern is prostate cancer, which is common in all men in their 80s and even a bit more likely in men with blood in their semen.

At age 85, we don’t recommend screening for prostate cancer. Most cases of prostate cancer found in men in their 80s are so slow-growing that aggressive treatment would just cause them more harm than good. Prostate cancer treatment of any kind puts men at risk for sexual dysfunction and incontinence. Some men have a very hard time choosing not to get treated, even when it is clearly the best option overall. Still, getting a diagnosis and examining all of your options seems prudent to me.