Hematuria as the Initial Presentation of Ductal Prostate Adenocarcinoma: A Rare Case Report
Makaleler > Tam Makale · 2026
Yazarlar: Nahit Öğüt, Mehmet Şahin, Fuat KIZILAY
Journal of Surgery, Uluslararası, 2026, cilt 11
DOI: 10.29011/2575-9760.011651
Özet
Background: Ductal adenocarcinoma of the prostate is a rare and aggressive histological subtype of prostate cancer that may present with atypical urinary symptoms such as gross hematuria.Because of its periurethral localization and occasionally misleading Prostate-Specific Antigen (PSA) levels, diagnosis may be delayed.Case Presentation: A 77-year-old man presented with intermittent gross hematuria persisting for two months.One year earlier, he had undergone bipolar Transurethral Resection Of The Prostate (TUR-P) for obstructive lower urinary tract symptoms, and histopathology had revealed benign prostatic hyperplasia with a PSA level of 2.57 ng/mL.At the current presentation, PSA was elevated to 12.8 ng/mL.Pelvic magnetic resonance imaging and computed tomography urography demonstrated a large 10 × 9 cm cystic-necrotic pelvic mass originating from the prostate together with a metastatic lesion at the S4-S5 vertebral level.Endoscopic resection and biopsy revealed pure ductal adenocarcinoma of the prostate with Gleason score 4+4=8 (WHO ISUP Grade Group 4).The patient received androgen deprivation therapy combined with enzalutamide followed by local radiotherapy.Follow-up evaluation demonstrated marked biochemical and radiological response with PSA regression from 72 ng/mL to 0.5 ng/mL and significant tumor shrinkage on magnetic resonance imaging.Conclusion: Ductal prostate adenocarcinoma may present with gross hematuria despite previously benign pathology and relatively low PSA levels.Rare aggressive prostate malignancies should be considered in elderly male patients presenting with unexplained hematuria.