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Central Journal of and Research

Case Report *Corresponding author Cabir Alan, Sahil yolu cad. No: 5, Kepez, Çanakkale, Turkey, Tel: 90-505-265-86-51; Email: Primary Urothelial Submitted: 18 February 2015 of the : A Case Report Accepted: 13 April 2015 Published: 14 April 2015 1 1 1 2 Ali Erhan Eren , Cabir Alan *, Emrah Demirci and Nihal Kilinc Copyright 1Department of Urology, Canakkale Onsekiz Mart University, Turkey © 2015 Alan et al. 2Department of , Canakkale Onsekiz Mart University, Turkey OPEN ACCESS

Abstract Keywords Prostate is common and frequently a lethal type for men. While it would • Prostate cancer be diagnosed through Digital (DRE) by the 50s, the gold standard • Prostate diagnosis method for this disease is achieved through the pathological examination • Primary urothelial carcinoma of prostate of the samples obtained through needle biopsy. The results of the , i.e. pathological diagnosis, can be grouped into four: benign prostate hyperplasia, , Prostatic Intraepithelial Neoplasia (PIN) and Atypical Small Acinar Proliferation (ASAP). Urothelial carcinoma diagnosis is less often and is generally accompanied by urothelial carcinoma in the bladder or prostatic as primary focus.

INTRODUCTION and biclutamide medication. When he came back for control 3 months later, his PSA level was found to be 14.4 ng/ml. The Prostate cancer is common and frequently a lethal type patient, clinically relieved by the administered alpha-blocker, for men. While it would be diagnosed through Digital Rectal was planned to continue the current treatment as he did not Examination (DRE) by the 50s, the gold standard diagnosis comply with the suggested treatment and did not adhere to the method for this disease is achieved through the pathological follow-up advices thoroughly. examination of the samples obtained through needle biopsy. The results of the prostate biopsy, i.e. pathological diagnosis, can be DISCUSSION grouped into four: benign prostate hyperplasia, adenocarcinoma, Prostate cancer is the second most frequent type of cancer Prostatic Intraepithelial Neoplasia (PIN) and Atypical Small seen in males with 899,000 new cases each year (14% of all Acinar Proliferation (ASAP). Urothelial carcinoma diagnosis is cancer cases in males) [1,2]. Prostate cancer would be diagnosed less often and is generally accompanied by urothelial carcinoma through Digital Rectal Examination (DRE) by the 50s. Currently, in the bladder or as primary focus. However, clinical localized prostate cancer is diagnosed through the though rarely, primary urothelial carcinoma can be reported. histopathological assessment of the samples obtained through This paper presents a case of urothelial carcinoma detected prostate needle biopsy [3]. Prostate biopsy would initially be through prostate biopsy, along with the relevant literature. performed in DRE guidance through transperineal approach CASE PRESENTATION

A 73-year-old man admitted to the polyclinic with low urinary [4].during the 30s when prostate biopsy was first defined, and later tract symptoms. His physical examination resulted with a +1 DRE on through transrectal approach which was defined by Astraldi score and his prostate was found to be adenomatous. The genital Transrectal Ultrasound guided (TRUS) biopsy performed examination turned out to be normal. His routine screenings exhibited a blood creatinine value and urinalysis value within normal ranges, while his serum PSA level was 48.9 ng/ml. No within the 6 80squadrants, was first whereas systematically it is currently defined performed by Hodge with et al. 8-13 [5]. pathology was detected by urinary system ultrasonography quadrantsIn its early [6,7]. days Now, of definition, random TRUS this biopsy guided would biopsy be is performedthe golden and the prostate volume was found to be 48 cc. 12 quadrant standard for the pathological diagnosis of prostate [8]. The prostate biopsy was performed due to the high level of PSA subject in this study was performed 12-quadrant biopsy. level and 4 quadrants were found to have intraductal urothelial Indicators for prostate biopsy were high level of serum carcinoma. The density of the tumor, detected to be positive in 2 right quadrants and 2 left quadrants, was found to be 5-15% cancer arising from the DRE. In this case, while the outcomes in all quadrants. Abdominal contrast tomography was made and ofProstate the DRE Specific were found Antigen normal, (PSA) the and/or serum suspicion PSA level ofwas prostate found the patient was suggested cystoprostatectomy. As he refused above the normal range; therefore the patient was planned for the suggested treatment, he was given acetate depot performing biopsy.

Cite this article: Eren AE, Alan C, Demirci E, Kilinc N (2015) Primary Urothelial Carcinoma of the Prostate: A Case Report. J Urol Res 2(2): 1023. Alan et al. (2015) Email: Central

The results of the prostate needle biopsy, i.e. pathological diagnosis, can be grouped into four: Benign Prostate Hyperplasia (BPH), adenocarcinoma, Prostatic Intraepithelial Neoplasia (PIN) and Atypical Small Acinar Proliferation (ASAP). While the pathological assessment of the cases reveals prostate cancer with a rate of 20-67%, the rest can be reported to be non-cancerous urothelial diagnosed by prostate needle biopsy. Moreover, [9]. a Onreliable the otherstaging hand, system there does isn’t not sufficientexist for prostatic data on urothelial carcinomas [10]. Due to the anatomical closeness, urothelial carcinoma of bladder can invade prostate. In case of suspicion about diagnosing adenocarcinoma or primary prostatic urothelial carcinoma in the pathological preparation analyzed after TRUS biopsy, precise discrimination between the two entities is important for making prognosis and treatment approach. Treatment for adenocarcinoma is generally limited to Figure 1 Microscopically, there are many benign prostate glands medical hormonal treatment or , primary mode of with foci of urothelial carcinoma (hematoxylin-eosin, original treatment for urothelial carcinoma is cystoprostatectomy and [11,12]. magnification ×40). While high-stage urothelial carcinoma and adenocarcinoma distinctive characteristics between them. Major criteria for pathologicalhave similar diagnosis pathological of the characteristics, cancerous tissue there in the are prostate specific inexistence of basal cells and nuclear atypia. PSA is the oldest biopsy samples are infiltrative glandular growth pattern, and most frequent immunohistochemical marker used to define negativeprostate-derived with a rate of 19% [13]. and 27% PSA in and cases prostate-specific of prostate-derived acid butphosphatase poorly differentiated are traditionally carcinomas used for [14,15]. verification. 2 markers They have can been be proved to be useful for the diagnosis of prostate adenocarcinoma: positive diagnostic tissue marker Alpha-Methyl-Acyl-Coenzyme A Racemase (AMACR) for prostate cancer; and p63 which is used in the diagnosis of prostate adenocarcinoma and does not stain the basal membrane in the atypical glands [16-18]. Cytokeratin Figure 2 (CK) 7, CK20 and High-Molecular-Weight Cytokeratin (HMWCK) have been analyzed as potential urothelial markers [19]. Photomicrograph showing urothelial carcinoma filing Whereas p63 is expressed by most of the urothelial carcinomas, prostatic duct (hematoxylin-eosin, original magnification ×100). PSA level for the subject in question decreased to undetectable it is negative in most of the prostate . p63 is a levels in 2 months [22]. In our case, the patient was advised reliable marker for urothelial differentiation and it can be used surgery, which he rejected. Medication (goserelin acetate depot and biclutamide tablet) was administered for the malignity, and differentiation between high-stage urothelial bladder carcinoma a partial response was achieved. andalong poorly with otherdifferentiated markers prostatein case ofadenocarcinoma difficulty in morphological [20]. In our case, pathological preparations were stained with hematoxylin- In conclusion, while primary urothelial carcinoma of prostate eosin and urothelial carcinoma was detected among the benign is rare, in case of detection, existence of a synchronous urothelial tumor should be investigated. Whereas the primary treatment approach is cystoprostatectomy, anti- treatment can Prognosis of high-grade urothelial carcinoma depends on the prostate tissues under 40X magnification Figure 1-2). also be administered. prostate invasion degree. No reliable system has been developed yet. Non-invasive prostatic transitional cell carcinoma REFERENCES can successfully be treated with conservative agents (TUR +/- 1. BCG), whereas invasive prostatic transitional cell carcinoma statistics. CA Cancer J Clin. 2011; 61: 69-90. should be treated aggressively with cystoprostatectomy [10]. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer In comparison to their acinar forms, such tumors exhibit a 2. -resistant and aggressive biological behavior, and a poor of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;Ferlay 127: J, Shin 2893-2917. HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates prognosis. Early diagnosis and radical surgery are the unique approaches that increase the [21]. However, 3. Humphrey PA. Diagnosis of adenocarcinoma in prostate needle biopsy in 2003, Morikawa et al. achieved a positive response in a case tissue. PubMed J Clin Pathol. 2007; 60: 35-42. with medical treatment without surgical intervention, and the 4. Astraldi A. Diagnosis of cancer of the prostate: biopsy by rectal route.

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Cite this article Eren AE, Alan C, Demirci E, Kilinc N (2015) Primary Urothelial Carcinoma of the Prostate: A Case Report. J Urol Res 2(2): 1023.

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