長期左下腹痛意外發現攝護腺癌

唐慈翊^1-3、曹曜軒¹

高雄市立小港醫院¹泌尿科

高雄醫學大學附設醫院²泌尿科

 高雄醫學大學醫學院³泌尿學科

Incidentally found abdominal tumor due to chronic lower abdominal pain

Tsz-Yi Tang^1,2,3, Yau-Hsuan Tsau^1,2

¹Department of Urology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung, Taiwan

²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

³Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan

Case report:

A 70-year-old male presented to the emergency department with chronic lower abdominal pain, particularly on the left side. Two months prior to the ED visit, he had undergone gastroenterology treatment and a colonoscopy, which did not reveal any abnormalities. Upon arrival at the ED, his vital signs were stable. Laboratory results showed a white blood cell (WBC) count of 12,320/μl, C-reactive protein (CRP) 3.49 mg/L, creatinine 2.92 mg/dL, and sodium (Na) 131 mmol/L. The patient's pain improved after receiving analgesics, and he requested to discharge and follow up at the urology clinic. At the urologic clinic, ultrasound revealed left-sided hydronephrosis and a left kidney stone, leading to a single session of extracorporeal shock wave lithotripsy (ESWL). However, the patient continued to experience flank pain, prompting an abdominal computed tomography (CT) scan. The CT scan showed bilateral hydronephrosis with suspected bladder tumor on the left lateral wall (Figure 1) and enlarged lymph nodes in the perivesical region. Also, a heterogenous and irregular mass in the prostate region at the sagittal view (Figure 2). Consequently, a transurethral resection of bladder tumor (TURBT) and left ureteroscopy tumor biopsy were performed. During ureteroscopy, multiple polyps in the left ureter was noted (Figure 3). Pathology revealed the bladder tissue was affected by cystitis cystica et glandularis, and the left ureteroscopy (URS) tumor biopsy showed inflamed granulation tissue. Transrectal ultrasound (TRUS) prostate biopsy identified adenocarcinoma with a Gleason score of 5+5.

Conclusion:

Prostate cancer in its early stages typically presents without symptoms, and when symptoms do manifest, they often indicate metastasis or advanced disease. The occurrence of hydronephrosis, especially when bilateral, should prompt an evaluation for prostate cancer as a potential cause. This connection emphasizes the need for diligent screening and diagnostic approaches to facilitate the early identification of aggressive prostate malignancies in patients with signs of obstructive uropathy.