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Foo MA, Lim EJ, Cheng CWS, Ng LG. Primary resection of oligometastatic recurrent prostatic carcinoma in the urethra. BMJ Case Rep 2022; 15:e250200. [PMID: 36130819 PMCID: PMC9494596 DOI: 10.1136/bcr-2022-250200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s presented to the emergency department with acute urinary retention following a 2-day history of gross haematuria with blood clots. He had a significant medical history of intermediate-risk prostate adenocarcinoma (grade group 2, prostate-specific antigen (PSA) 14.9 ng/mL) for which he underwent a robotic-assisted laparoscopic radical prostatectomy (RARP) 13 years ago. PSA nadir was achieved (<0.03 ng/mL). Three years after RARP, he had biochemical recurrence with PSA rising to 0.06 ng/mL. Salvage radiotherapy was performed with good PSA response back to nadir. Workup for gross haematuria included a flexible cystoscopy which revealed a lobulated fleshy lesion occupying the mid-penile urethra. Staging imaging showed no local recurrence at prostatectomy site or lymphadenopathy. PSA was 4.2 ng/mL. Surgical resection with primary repair of the urethra was performed. Postoperative recovery was good with PSA achieving nadir. Histology revealed an upgraded metastatic prostate adenocarcinoma, grade group 5.
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Affiliation(s)
| | - Ee Jean Lim
- Urology, Singapore General Hospital, Singapore
| | | | - Lay Guat Ng
- Urology, Singapore General Hospital, Singapore
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Masuda T, Kosaka T, Nakamura K, Hongo H, Yuge K, Nishihara H, Oya M. Multiple metastases of androgen indifferent prostate cancer in the urinary tract: two case reports and a literature review. BMC Med Genomics 2022; 15:118. [PMID: 35598018 PMCID: PMC9124419 DOI: 10.1186/s12920-022-01267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is mainly known to metastasize to bone, lung and liver, but isolated metastases of prostate cancer, including ductal carcinoma, in the urinary tract are very rare. We describe two patients with nodular masses in the urinary tract (the anterior urethra or the urinary bladder) that were found on cystoscopy during treatment of castration-resistant prostate cancer. CASE PRESENTATION In both cases, the pathological diagnosis from transurethral tumor resection showed that they were androgen indifferent prostate cancer (AIPC), including aggressive variant prostate cancer (AVPC) in Case 1 and treatment-induced neuroendocrine differentiation prostate cancer (NEPC) in Case 2. In Case 1, Loss of genetic heterozygosity (LOH) of BRCA2 and gene amplification of KRAS was identified from the urethra polyps. In Case 2, homozygous deletion was observed in PTEN, and LOH without mutation was observed in RB1. CONCLUSION These are the first reports of two cases of urinary tract metastasis of AIPC.
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Affiliation(s)
- Tsukasa Masuda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kohei Nakamura
- Genomics Unit, Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Hongo
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuyuki Yuge
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Nishihara
- Genomics Unit, Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Beiko D, Zaza K, Power KV, Siemens DR, Boag AH. Isolated anterior urethral recurrence of prostatic adenocarcinoma. Can Urol Assoc J 2014; 8:E361-3. [PMID: 24940466 DOI: 10.5489/cuaj.1692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Isolated anterior urethral metastases from prostate cancer are rare. The pathogenesis of this form of loco-regional recurrence may be related to spread by instrumentation-induced implantation and could potentially then be associated with a better prognosis than metastatic disease secondary to a more malignant phenotype. We report a case of a 68-year-old man with high-risk prostate cancer, diagnosed at transurethral resection of prostate, who was originally treated with combination external beam radiotherapy and hormonal therapy. He re-presented 4 years after his original diagnosis with recurrent gross hematuria and cystourethroscopic biopsies of anterior urethral polyps revealing isolated recurrent prostatic adenocarcinoma. We present our this case and review the literature.
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Affiliation(s)
- Darren Beiko
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Khaled Zaza
- Division of Radiation Oncology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Kevin V Power
- Division of Urology, Department of Surgery, Queensway Carleton Hospital, Ottawa, ON
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
| | - Alexander H Boag
- Department of Pathology, Queen's University, Kingston General Hospital, Kingston, ON
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Abstract
For imaging of the male urethra, conventional radiographic contrast studies including retrograde urethrography are most commonly utilized. They are best suited for delineating luminal abnormalities of the urethra and thus are commonly used as the primary imaging modality for patients with various urethral abnormalities such as trauma, inflammation, and stricture. More recently, the cross-sectional imaging techniques of ultrasound, computed tomography and magnetic resonance imaging have been utilized increasingly for urethral and periurethral abnormalities. These studies are most valuable as an adjunctive tool in patients with the complex anatomical derangements such as congenital anomalies, posterior (or bulbomembranous) urethral injuries, and with urethral or periurethral tumors. These cross-sectional techniques can be performed during micturition or with retrograde injection of saline or jelly through the urethral meatus to improve visualization of the urethral luminal abnormalities. This article describes imaging techniques, anatomy, and findings of various urethral and periurethral pathology in the male including congenital anomalies, infection/inflammation, stricture, traumatic injury, fistula, tumors, and calculi.
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Affiliation(s)
- Bohyun Kim
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Green JM, Tang WW, Jensen BW, Orihuela E. Isolated recurrence of ductal prostate cancer to anterior urethra. Urology 2006; 68:428.e13-5. [PMID: 16904476 DOI: 10.1016/j.urology.2006.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/02/2006] [Accepted: 03/13/2006] [Indexed: 11/19/2022]
Abstract
We report the case of a 74-year-old man with ductal prostate cancer who had originally undergone radiotherapy but developed metastases to the anterior urethral mucosa. This is the fourth such case ever reported in English publications. We suspect the metastases developed from implantation after instrumentation, a common finding in the previously reported cases. Although no specific treatment regimen exists, we believe that local resection followed by androgen deprivation is the treatment of choice in these patients.
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Affiliation(s)
- Justin M Green
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555, USA
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Blanco Díez A, Ruibal Moldes M, Rodríguez-Rivera García J, Fernández Rosado E, Alvarez Castelo L, Gómez Veiga F, González Martín M. [Metastasis of prostatic carcinoma to the urethra: report of a case]. Actas Urol Esp 2004; 27:735-8. [PMID: 14626686 DOI: 10.1016/s0210-4806(03)73006-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Penile metastases from prostate carcinoma are uncommon events, much more in urethra and corpus spongiosum, we add a case to the preexisting literature. A patient with hormone resistant prostate cancer consults for haematuria and voiding difficulties. During TURP we observe tumors at the penile urethra which are resected and result to be prostate cancer metastases. Patient is fine and without voiding disturbance after 7 months of following. We think is an interesant case because there is few reports in literature.
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Affiliation(s)
- A Blanco Díez
- Servicio de Urología, Hospital Universitario Juan Canalejo, La Coruña
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Abstract
Conventional radiographic contrast material-enhanced studies (eg, retrograde urethrography [RUG], voiding cystourethrography [VCUG], double-balloon catheter urethrography) and ultrasonography are useful in evaluating the anatomy of the urethra but are limited in demonstrating anatomic derangement of adjacent structures. Since the anatomic details of both the urethra and periurethral tissues can be evaluated noninvasively with magnetic resonance (MR) imaging, this modality can be used as an adjunctive tool for evaluation of urethral abnormalities. In patients with congenital anomalies, MR imaging is reserved for cases of intersex anomalies or complex genitourinary anomalies, in which evaluation of internal organs is essential. MR imaging may demonstrate diverticula that are not seen on radiographic contrast-enhanced studies, including VCUG, RUG, or double-balloon catheter study. In cases of inflammation, MR imaging can demonstrate not only inflammatory infiltration around the urethra but also the presence of a periurethral abscess or sinus tract. In cases of trauma, MR imaging is helpful in assessing the presence and extent of anterior or posterior urethral injury and predicting the occurrence of complications. At MR imaging, a fistula can be seen as a direct communicating channel with an adjacent organ. In patients with urethral tumors, the major role of MR imaging is in local staging.
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Affiliation(s)
- J Ryu
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea
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