Incidental Locally advanced Prostatic Adenocarcinoma Mimicking Bladder Tumour: A Case Report.

Abstract

Introduction: Prostate malignancy originating from the base of the prostate can invade the urinary bladder and frequently misdiagnosed clinically as urinary bladder tumor. We report a case of incidental locally advanced adenocarcinoma of the prostate mimicking bladder tumor. The aim is to emphasize on the atypical presentation of the prostatic adenocarcinoma with unusual normal serum prostate specific antigen. Case report: He is a 53 year old man who presented with predominantly bothersome storage lower urinary tract symptoms. Rectal examination revealed a mildly enlarged prostate with benign features. Urologic scan revealed a 5 x 5mm mass around the bladder neck. The prostate size was normal (23.04g). Prostate specific antigen was 1.5ng/ml. Urethrocystoscopy revealed a mildly enlarged prostate with a 5 x 10mm tumor at the area of the bladder trigone. He had transurethral resection of bladder tumor metastatic tumor from the prostate.Based on the histological diagnosis, he was further evaluated. Twelve-core trans-rectal ultrasound (TRUS) guided biopsy of the prostate confirmed adenocarcinoma of the prostate with a Gleason's score of 4+4=8. Pelvic magnetic resonance imaging showed features of both visceral and bony metastatic deposits. Whole body bone scan showed no evidence of osteoblastic skeletal met a stasis. He is currently a waiting immunohistochemistry. Conclusion: A combination of high index of suspicion, cystoscopy, and histological analysis of biopsy specimen as well as immunohistochemistry is valuable in disease confirmation in patients with normal serum prostate specific antigen.