Urologic Cancers Expert Forum
Urological cancer
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Urological cancer

Im a 44 yold male with the cancer gene mutation MSH 2 Lynch syndrome strong family history.July 08 had CT SCAN found negative DR did scope found low grade Bladder carcinoma  CT Scan did not pick up had TURBT to remove.On 3 month scope for testing.Nov 08 urogram showed 1cm nodule posterior Bladder Wall.Had scope Dr saw nodule said wait 3 months .Late Jan 09 pain in groin ,lower back and left thigh Dr didt CT SCan again was normal the Following day they did a ultrasound found 2.3cmx1.3cmx1.4cm HYpoechoic mass sittuated between Bladder and prostate.Dr did another scope Bladder is neggative. Dr sent me for a Endo-Rectal MRI which said LOW T3 signal in the Peripheral zone extending from the left base to mid gland with capsular irregularity suspicious for extracapsular extension. From this the Dr sent me for a Rectal Biposie of Prostate which came back Negative and my PSA levels were a low 0.56.Dr seemed complexed did another CT Scan with contrast which came back negative.He sent me for another Ultrasound which said The Bladder No2 mural masses are seen.Between the Bladder and Prostate is a Hypoechoic Mass measuring 2.3cmx2.2cmx2.4CM  with slightly irregular borders.as you can see it has grown since the Nov 08 1cm nodule to the Feb 09 2.3x1.3x1.4 mass. CT SCANS never picked anything up.I have many concerns since this mass is growing between the bladder and the prostate and thats why they cant see it with cystoscope and CT scans.I am wondering if this is cancer and I was told Prostate biposie can also come back false negative.Looking for answers since the Drs seemed complexed and with the family history and Having Bladder cancer in Julu 08 .Im getting very nervous looking for some opinions.Im on my 2nd opinion and the Dr is saying if he goes in to remove this mass I might lose my Baldder and Prostate he also said he might do a laproscopic biopsie thru my Stomach.Having many concerns since this is affecting my Job.Looking for some opinions
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Thank you for the question. You are describing two different conditions, bladder cancer or transitional cell carcinoma (TCC) and prostate cancer. When prostate cancer is confined to the bladder (i.e not involving other organs) surgery is recommeded and the prostate gland gets removed. Similarly in bladder cancer the bladder gets removed. In either case a biopsy gives the definite diagnosis. Your case is not common since PSA and eMRI results were contradictory. Since the cancer showing on MR involves a major part of the prostate it is most likely that the needle biopsy is a true negative. A more thorough and immediate investigation of the tumor growing between the bladder and the prostate is recommended. The described picture is confusing because bladder cancer tends to extend to the surrounding tissues (muscle and bone). However extension to the prostate gland remains possible.
If the cancer involves both the bladder and prostate, this would mean they both need to be surgically resected which will affect your quality of life.

Best of luck in the new year.

Sincerely,

Ash Tewari, MD
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