A patient goes to the hospital for a routine procedure to treat an enlarged prostate. And, unexpectedly, a test done at the hospital—perhaps a blood test or an X-ray or an examination of the urethra and bladder—finds a cancer.
Apparently, something like this happened to King Charles III. When the British monarch was treated for an enlarged prostate in January, doctors found a cancer that the palace said was not prostate cancer. Charles started treatment on Monday. The palace did not reveal what had led to the king’s diagnosis.
While some prostate specialists like Dr. Peter Albertsen 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 had come in for a routine prostate checkup to watch for a low-risk cancer. One of the residents of Dr. Brawley ordered a chest X-ray “for no reason,” he said. But to Dr. Brawley’s surprise, the X-ray found lung cancer.
Some cancers require immediate treatment, while for others, treatment can wait, oncologists said. The palace did not describe the severity of Charles’ diagnosis, nor the treatment he was receiving.
Some blood cancers are among those that need immediate treatment, Dr. Brawley said.
“We even have some leukemias and lymphomas where we want to start treatment less than 24 hours after suspicion,” he said. She said she doubted Charles had one of the most aggressive blood cancers, acute myeloid leukemia, nor Burkitt lymphoma. But if he did, the treatment will not be postponed.
These are cancers “that we jump at,” Dr. Brawley said. He added, “These are things we start dealing with in the middle of the night if we have to.”
It is not known if the king’s cancer was detected as doctors were preparing for surgery, which may be preceded by a blood test, CT scan or MRI. Doctors may also detect another type of cancer when they pass a field through a patient’s urethra during treatment of an enlarged prostate.
Dr. Benjamin Breyer, a urologist at the University of California, San Francisco, noted that if cancer is accidentally found in a man’s prostate and turns out not to have come from there, that can be a dire situation.
“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 known as urothelial carcinoma could also occur in the prostate.
This type of bladder cancer is the most likely non-prostate cancer to be found as part of treatment for 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 urethra, he explained. Cancer can be detected during prostate treatment “when you scrape the inside of the prostate.”
There are two types of this bladder cancer, said Dr. Judd Moul, a urologic oncologist at Duke. One is “more of an embarrassing situation,” he said. The cancer is surgically removed and medicine is placed in the bladder periodically to treat any residual cells.
The other type, called myoaggressive, is serious. The treatment is complete removal of the bladder.
“Let’s hope and pray that it isn’t,” Dr. Mull said.
But by far the most common cancer found during treatment for an enlarged prostate is prostate cancer. This happens in about 5 percent to 10 percent of cases, Dr. Breyer estimated, although one study reported that prostate cancers were found in 26 percent of cases when men were treated for an enlarged prostate.
With King Charles, there is very little information to guess what kind of cancer he has or how it was discovered, Dr. Breyer and others said.
