I forgot to mention about incidental prostate cancer. The incidental prostate cancer is when the prostate cancer is found by accident when they were examining a patient for non prostate cancer related diseases. University of Southern California and University of Iowa did such studies based upon the patients who had radical cystectomy.
University of Southern California checked 1,476 patients who underwent RCP (radical prostatectomy) between 1970 and 2008 for urothelial carcinoma of the bladder (without prior known history of prostate cancer), 559 patients (38%) were identified to have incidental prostate adenocarcinoma. Please note is seems that the procedure to remove the prostate including during radical cystectomy for bladder cancer is called RCP(radical prostectomy). Anyway, 38% of bladder cancer patients who had removed the bladder happened to have prostate adenocarcinoma.
University of Iowa found that 34% of the bladder cancer patients who had radical cystectomy was found to have prostate cancer (adenocarcinoma).
A study looking at autopsy of general public who were not known to have prostate cancer before they died found prostate cancer from 5% at age of 30 and under and 59% at age greater than 79 years old. So the data from USC and University of Iowa make sense because 1 in 9 males will have prostate cancer according to American Cancer Society website and 90% of bladder cancer patients are over 60 years old at the time of the initial diagnosis.
So, though they found a lesion by MRI which was done because of the rise in the PSA value of your husband, high percentage of males - seniors have prostate cancer anyway regardless of the status of other disease, including bladder cancer. Please note that many prostate cancers are slow growth and will not affect much the patients. It is known that many men die with other causes without knowing that they had prostae cancer.
This is another reason I think the lesion found is prostate originated.
Link to the paper by Univesity of Iowa regarding incidental prostate cancer of bladder cancer patients who removed the bladder.
First of all, I do not have any medical background. So, I was hesitant to post my reply as the information I have is limited to my own experience and "Googling". So, please read with a big grain of salt.
I am sorry to hear that your husband feels tired. In my case, when the first CT scan was done, not only they found a mass in my bladder and the enlarge prostate pushing my bladder. My urologist had a challenge time to put a scope as the prostatic urethra (the portion of urethra going through the prostate) was squeezed by the enlarged prostate. So, about six months after my bladder cancer was diagnosed with non-muscle-invasive and intermediate grade, I had a surgery to scrape out much gland. Luckily the biopsy of the gland was benign. Before the surgery, I had problem of holding pee. Perhaps, because of the anxiety of always thinking about it and going through the initial stage of being a bladder cancer patient, my blood pressure went up high. So, I was put on blood pressure pills.
When I was attending a local prostate cancer support group, I did not met anyone who had developed prostate cancer from bladder cancer but I became aware of cases prostate cancer patients developed bladder cancer from the treatments. A guest urologist mentioned that he had recently seen patients who had a radiation therapy in the past for the prostate cancer developed the bladder cancer. There is also a treatment called prostate brachytherapy or internal radiation therapy which places many radioactive seeds into the prostate. I know a patient who developed bladder cancer because a seed got into the bladder.
In terms of bladder cancer progressing into the prostate, the study I listed showed that if the bladder cancer is stage 4a, which means the cancer also penetrated through the muscle layer and the fat layer, it could go to the prostate. This would not apply to non-muscle-invasive bladder cancer. But, the same study reported that some T2,T3 muscle invasive bladder cancer patients and including non-muscle-invasive patients showed the cancer in the prostatic urethra (the portion of urethra going through the prostate) or prostate duct. Please note that the study was based on those patients who had radical cystectomy. Please note that the study does not say how many patients out of 1400 patients who had radical cystectomy were non-muscle-invasive patients or why non-muscle-invasive patients decided to have radical cystectomy though I suspect that intravesical BCG did not work to them. Anyway, I would expect that the number of non-muscle-invasive bladder cancer patients who had successful BCG treatments or in the treatment will have prostate involvement only in rare cases.
So, I think it is likely a prostate related lesion. Because the prostate consists of many mucous glands that secretes fluid to carry semen at ejaculation, the healthy prostate look white in MRI. A lesion is usually a darker spot in the MRI image. Incidentally, adenocarcinoma (adeno means gland in Greek) is the most common cancer in the prostate. Often, it can be controlled by stopping the external stimulus, the male hormone testosterone. But bladder cancer ( urothral carcinoma ) grows without external stimulus. They are different even in genomic analysis.
I have watched a few videos in which pathologists explain how to distinguish adenocarcinoma from the area which looks abnormal but not adenocarcinoma, caused by inflammation, infection and other reasons. So, it is possible
the lesion in the MRI image could be something else than adenocarcinoma.
Incidentally, it is good that MRI was done first. They know the location where they get biopsy from. In the past, they sometime pissed the spot. I have read that now a days, they use MRI assisted biopsy so they do not miss the spot. Also I expect that they would get samples from different spots of the prostate.
I hope the biopsy on 18th goes smooth. It is noted that according to cancer.net the 5-year survival rate for most men with local or regional prostate cancer is nearly 100% compared to 77% of bladder cancers. So, the odds is in your husband's favor.
Interesting. So the lesion could be unrelated prostate cancer or still could be nothing but not likely metastatic bladder? My only red flag that could also be nothing is that in the last few months, he seems more frail, slower.
The biopsy is scheduled for 8/18, if his Covid-19 test is negative.
Below is the link to Mayo click study on prostatic involvement of bladder cancer.
- They had 1404 radical cystectomy between 1980 to 2006.
- Of 1404 patients, 201 patients had prostatic involvement (prostate cancer).
- Of 201, 75 patients were non-muscle-invasive bladder cancer patients.
- Most of non-muscle-invasive bladder cancer patients did have BCG treatment, but the report did not say
if they were BCG non-responsive patients or not.
Interestingly, several studies I read excluded prostate cancer as metastasis by bladder cancer. They include distant organs, including lymph nodes. MRI should be able to tell if lymph nodes were affected.
Very unlikely to be prostate cancer if it was in the bladder. Unlikely to be mets since it is in the bladder. You will just need to wait and discuss this with the doctor. It is probable that he will want to do a TURB.
Good luck to you both
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society