A patient presents to the hospital for a routine procedure to treat an enlarged prostate. And, unexpectedly, a test at the hospital – perhaps a blood test, an X-ray, or an examination of the urethra and bladder – reveals cancer.
Apparently something similar happened to King Charles III. When the British monarch was treated for an enlarged prostate in January, doctors discovered cancer that the palace said was not prostate cancer. Charles started treatment on Monday. The palace did not reveal what led to the king’s diagnosis.
While some prostate specialists, such as Dr. Peter Albertsen of the University of Connecticut, have called such situations “fairly rare,” other doctors said they are not uncommon.
Dr. Otis Brawley, an oncologist at Johns Hopkins Medical Center in Baltimore, said a man came in for routine prostate monitoring to watch for a low-risk cancer. One of Dr. Brawley’s residents ordered a chest X-ray “for no reason,” he said. But to Dr. Brawley’s surprise, the X-ray detected lung cancer.
Some cancers require immediate treatment, while for others, treatment can wait, oncologists said. The palace did not describe the seriousness of Charles’ diagnosis, nor the treatment he was receiving.
Some blood cancers are among those that require immediate treatment, Dr. Brawley said.
“We even have a few leukemias and lymphomas that we want to start treatment for within 24 hours of suspicion,” he said. He said he doubted Charles had one of the more aggressive blood cancers, acute myeloid leukemia or Burkitt’s lymphoma. But if he did, the treatment would not be postponed.
These are cancers “that we are rushing to,” Dr. Brawley said. He added: “These are things we start dealing with in the middle of the night if we have to. »
It is unclear whether the king’s cancer was discovered while doctors were preparing for surgery, which can be preceded by a blood test, CT scan or MRI. Doctors can also detect another type of cancer by passing an endoscope through a patient’s urethra during treatment for an enlarged prostate.
Dr. Benjamin Breyer, a urologist at the University of California, San Francisco, noted that if cancer is accidentally discovered in a man’s prostate and it turns out not to have originated there, the situation can be disastrous.
“It is by definition a metastasis,” Dr. Breyer said. Cancers that can spread to the prostate include melanomas, he said. A type of bladder cancer called urothelial carcinoma may also appear in the prostate.
This type of bladder cancer is the nonprostate cancer most likely to be detected in the treatment of an enlarged prostate, said Dr. Scott Eggener, a urologic oncologist at the University of Chicago. The inner lining of the bladder has become cancerous and is spreading through the urinary tube, he explained. Cancer can be detected during prostate treatment “when you scratch the prostate from the inside.”
There are two types of bladder cancer, said Dr. Judd Moul, a urologic oncologist at Duke. One of them is “more of a harmful condition,” he said. The cancer is scraped surgically and medications are periodically introduced into the bladder to treat the remaining cells.
The other type, called muscular invasive, is serious. Treatment consists of complete removal of the bladder.
“Let’s hope and pray that it’s not that,” Dr. Moul said.
But by far the most common cancer discovered during treatment for an enlarged prostate is prostate cancer. This happens about 5 to 10 percent of the time, Dr. Breyer estimates, although a study reported that prostate cancers were detected in 26 percent of cases when men were treated for an enlarged prostate.
With King Charles, there is simply too little information to guess what type of cancer he had or how it was discovered, Dr. Breyer and others said.