Basal Cell Carcinoma of the Prostate Misdiagnosed as High-Grade Urothelial Cancer – A Case Report of a Diagnostic Pitfall

Abstract

Purpose Basal cell carcinoma of the prostate is rare. Usually, it is diagnosed in elderly men with nocturia, urgency, lower urinary tract obstruction and normal PSA. Case Presentation We report on a case of a 56-years-old patient who presented at the emergency ward with weight loss, nausea and vomiting. The diagnostic evaluation showed acute renal failure due to a bladder tumor. After admission to the urology ward and subsequent contrast-enhanced CT urography and contrast-enhanced chest CT, a non-metastatic bladder tumor that infiltrated the right side of the bladder and seminal vesicles was found. High-grade muscle-invasive urothelial carcinoma was diagnosed from TURBT specimens, followed by radical cystoprostatectomy with pelvic lymphadenectomy and formation of ureterocutaneostomy sec. Bricker. The histopathological examination of the resection specimen surprisingly revealed the presence of prostatic basal cell carcinoma pT4N0M0 and not urothelial cancer. Due to renal failure, the patient required hemodialysis. The recommendation of the multidisciplinary oncological meeting was to follow up with the patient by the surgeon-urologist. On imaging six months after surgery, it was suspicious for recurrence. Patient was considered for adjuvant oncological treatment. Conclusion Although rare, basal cell carcinoma of the prostate should be considered in patients with lower urinary tract symptoms, hematuria and normal PSA. Transurethral resection of bladder tumor is indicated in patients presenting with hematuria and bladder tumor. In evaluation of such cases rare histological types should be included in the differential diagnosis.

Prostate-Specific Antigen as an Ultrasensitive Biomarker for Patients with Early Recurrent Prostate Cancer: How Low Shall We Go? A Systematic Review

“…The heterogeneity in the duration of followup may explain part of the differences in mortality between the studies. A histologic type of PCa did not produce PSA [163,164]; therefore, PSA could not detect recurrence in patients with that histology. Finally, our SR only evaluated blood tests and did not evaluate PSA derivatives, circulating tumor cells [165], SCHLAP1 [166,167], other long non-coding RNA [168] or genomic classifiers [169,170].…”

Adenoid cystic/basal-cell carcinoma of the prostate following high-grade urothelial bladder cancer: a case report

“…The presented case is unique in presenting incidental diagnosis of ACC/BCC after transurethral resection of noninvasive high-grade carcinoma (pTa) in a patient with obstructive symptoms and normal serum PSA level. In the literature so far, there is only one reported case of a patient with high-grade muscle-invasive carcinoma, with incidentally diagnosed ACC/BCC [ 4 ]. In the presented case patient denied a family history of cancer and tobacco smoking was the risk factor for urothelial carcinoma.…”

“…Even though there is no proven mutual correlation between ACC/BCC and urothelial bladder cancer, recently one case of ACC/BCC following urothelial bladder cancer was published [ 4 ].…”