Primary Urothelial Carcinoma of the Prostate: A Rare Disease With Treatment Dilemma

Primary urothelial carcinoma of the prostate (UCP) is extremely rare. The exact pathogenesis of this disease is not known. Currently, there is no consensus regarding the optimal treatment. Reporting more such cases is essential. This can help researchers better understand the disease and identify the optimal treatment. Here we report a case of primary UCP in a man who presented with acute urinary retention (AUR). We also would like to share our treatment method. A 45-year-old man presented to the emergency department with acute urinary retention. Ultrasound screening showed an echogenic soft tissue lesion in the prostatic urethra extending to the bladder neck region, with increased vascularity on color Doppler imaging. The urinary retention was relieved by Foley catheterization, The presence of growth in the prostatic urethra was confirmed by urethrocystoscopy. He underwent transurethral resection of the tumor and prostate followed by intravesical BCG (Bacillus Calmette-Guérin) instillation. We performed regular check urethrocystoscopy and there were no features of local recurrence till the last follow-up (i.e., 30 months). Even though primary UCP is rare, clinicians have to keep in mind the possibility of this disease during evaluation for lower urinary tract symptoms. Till today there is no consensus on the standard treatment protocol for UCP and the available literatures are also limited. From our case study, it appears that transurethral resection of the prostate, followed by intravesical BCG instillation, is a potential treatment modality for primary UCP, especially for patients who refused radical surgery.