A patient is admitted to the hospital to undergo 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 exam of the urethra and bladder – detects cancer.
Apparently, something like this happened to King Charles III.
When the British monarch was treated for an enlarged prostate in January, doctors found cancer that, according to the palace, It's not prostate.
Carlos started treatment on Monday.
The palace did not reveal what had led to the king's diagnosis.
The news of King Charles III's cancer in the British newspapers.
Although some prostate specialists, such as Dr. Peter Albertsen of the University of Connecticut, called these situations “quite rare“, other doctors said were not unheard of.
Dr. Otis Brawley, an oncologist at Johns Hopkins Medical Center in Baltimore, said a man had come in for routine prostate surveillance to monitor a low-risk cancer.
One of Brawley's residents ordered a chest X-ray “for no reason,” he said.
But to Brawley's surprise, the x-ray detected a 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, or what treatment he was receiving.
Some blood cancers are among those that need immediate treatmentBrawley said.
“We even have some leukemias and lymphomas where we want to start therapy less than 24 hours after suspicion,” he said. Brawley doubted that Charles had one of the most aggressive blood cancers, acute myeloid leukemia, or Burkett lymphoma.
But if you had it, the treatment would not be postponed.
These are cancers “that we jump on,” Brawley said.
And he added: “These are things that we start dealing with in the middle of the night if necessary.”
It is unknown whether the king's cancer was detected when doctors were preparing for the operation, which may be preceded by something such as a blood test, a CT scan or an MRI.
Doctors can also detect another type of cancer by passing an endoscope through the patient's urethra during treatment for an enlarged prostate.
Dr. Benjamin Bryer, a urologist at the University of California, San Francisco, noted that if cancer is detected iaccidentally in a man's prostate and it turns out that it did not originate there, the situation can be serious.
“It is, by definition, a metastasis,” says Bryer.
Among the cancers that can spread to the prostate are melanomas.
A type of bladder cancer known as urothelial carcinoma can also appear in the prostate.
According to Dr. Scott Eggener, a urologic oncologist at the University of Chicago, this type of bladder cancer is the most likely of the types that do not affect the prostate to be detected as part of treatment for an enlarged prostate.
The inner lining of the bladder has become cancerous and spreads into the urinary tract, he explained.
Cancer can be detected during prostate treatment “when the prostate is scraped from the inside.”
There are two types of this bladder cancer, said Dr. Judd Moul, a urologic oncologist at Duke. One is “more of a nuisance,” he said.
The cancer is removed surgically, and medications are periodically given to the bladder to treat residual cells.
The other type, called muscle invasive, is serious.
The treatment consists of complete removal of the bladder.
“Let's hope and pray it's not that,” Moul said.
But by far the most common cancer detected during treatment for an enlarged prostate is prostate cancer.
Bryer estimates that this occurs 5% to 10% of the time, although one study found that prostate cancer was detected in the 26% of cases of men treated due to enlarged prostate.
In the case of King Charles, there is too little information to guess what type of cancer he has or how it was discovered, according to Bryer and others.
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