Giant organ confined prostatic adenocarcinoma: a case report

We describe a case of an otherwise healthy 71-year-old African male who presented with a PSA of 5800 ng/ml and a prostate volume of over 1000cc. Unique aspects of this case include the size of the prostate, the apparent absence of distant metastases, and the safe usage of transabdominal biopsy of this mass.We present this case report and review of literature to generate further discussion amongst readers as to management options for this difficult case.Giant prostatic adenocarcinoma represents a rare and challenging treatment dilemma. Previous reports [1,2] describe a few cases of this condition and their initial clinical and radiologic presentation. With increased use of PSA screening since that time, there have been no additional cases reported in the recent literature. In this case report, we describe an otherwise healthy male who presented with a PSA of 5800 ng/ml and a prostate volume of over 1000cc. Unique aspects of this case include the size of the prostate, the safe usage of transabdominal biopsy of this mass, and the apparent absence of distant metastases. The authors would like to generate further discussion amongst readers as to management options for this difficult case.A 71-year-old African male was referred from an outside hospital for further management after initially presenting with daytime frequency and nocturia. The patient reported symptomatic relief with tamsulosin 0.4 mg once a day. However, a serum PSA obtained by the primary care physician was 5874 ng/ml.On initial presentation, he reported minimal lower urinary tract symptoms. He complained of nocturia 2–3 times per night, which had improved with one month of tamsulosin. Review of systems was negative. His past medical history was significant for hypertension treated with Atenolol 50 mg once a day. He had no known allergies and no family history of genitourinary malignancy. On physical exam, the patient was a well-nourished male in no distress. Examination of his abdomen revealed a lower ab