A patient checks into the hospital for a routine procedure to treat an enlarged prostate. And, unexpectedly, a test done in the hospital – perhaps a blood test or an X-ray or an examination of the urethra and bladder – detects cancer.
Apparently, something similar happened to King Charles III. When the British monarch was treated for an enlarged prostate in January, doctors discovered cancer, which the palace said was not prostate cancer. Charles’ treatment started on Monday. The palace did not reveal what led to the king’s diagnosis.
While some prostate experts, like Dr. Peter Albertson at the University of Connecticut, called such conditions “fairly rare,” other doctors said they were not unheard of.
Dr. Otis Brawley, an oncologist at Johns Hopkins Medical Center in Baltimore, said a man came in for routine prostate monitoring to monitor for low-risk cancer. One of Dr. Brawley’s residents ordered a chest X-ray “for no reason,” he said. But Dr. Brawley was surprised when an X-ray revealed lung cancer.
The oncologist said some cancers require immediate treatment, while others may have to wait for treatment. The palace did not describe the severity of Charles’ diagnosis, nor what treatment he was receiving.
There are some blood cancers that require immediate treatment, Dr. Brawley said.
“We also have some leukemias and lymphomas where we want to start therapy less than 24 hours after suspicion,” he said. He said he suspected that Charles had acute myeloid leukemia, one of the most aggressive blood cancers, nor Burkitt lymphoma. But if he did so, the treatment would not be stopped.
These are the cancers “we jump on,” Dr. Brawley said. He added, “These are things that if we had to treat, we would start at midnight.”
It is not known whether King’s cancer was found as doctors prepared for surgery, which may have been preceded by something like a blood test, CT scan or MRI. Doctors may also detect another type of cancer by passing a scope through the patient’s urethra during treatment for an enlarged prostate.
Dr. Benjamin Breyer, a urologist at the University of California, San Francisco, said that if cancer is found incidentally in a man’s prostate and it turns out that it did not originate there, it could be a serious condition.
“It is, by definition, a metastasis,” Dr. Breyer said. Cancers that can spread to the prostate include melanoma, he said. A type of bladder cancer known as urothelial carcinoma can also appear in the prostate.
This type of bladder cancer is the most likely non-prostate cancer found as part of treatment for an enlarged prostate, said Dr. Scott Agner, a urological oncologist at the University of Chicago. He said the inner lining of the bladder had become cancerous and had spread through the urinary tract. Cancer can be detected during prostate treatment “when you scrape the prostate from the inside.”
There are two types of bladder cancer, said Dr. Judd Maul, a urological oncologist at Duke. “There is a more nuisance situation,” he said. The cancer is surgically removed and medicine is periodically injected into the bladder to treat any remaining cells.
The second type, called muscle invasiveness, is serious. Treatment involves complete removal of the bladder.
“Let’s hope and pray that’s not the case,” Dr. Maul said.
But by far the most common cancer found during treatment for enlarged prostate is prostate cancer. This happens in about 5 percent to 10 percent of cases, Dr. Breyer estimates, although one study reported that prostate cancer was found in 26 percent of cases when men with enlarged prostates were treated.
Dr. Breyer and others said there is too little information about King Charles to guess what type of cancer he had or how he was diagnosed.
