Urothelial carcinoma of the prostate with raised β-hCG levels: a case report

Abstract

Background Trophoblastic differentiation in primary urothelial carcinoma of the prostate is extremely rare. An increased level of β-subunit human chorionic gonadotropin in serum in urothelial carcinoma is detected in approximately 30% of cases. To our knowledge, increased concentration of β-subunit human chorionic gonadotropin in serum in prostatic urothelial carcinoma has never been reported and its clinical significance is not evaluated yet. Case report Here we present the case of a 67-year-old European patient who was admitted to the hospital with hematuria, dysuria, and enlarged painful testis. Ultrasonographic examination of the testis did not reveal any focal lesion. Magnetic resonance imaging of the pelvis showed a tumor of 62 mm diameter mainly located in the posterior part of the prostatic gland. A pathological examination from cystoscopy biopsy allowed us to set the diagnosis of high-grade invasive urothelial carcinoma with trophoblastic differentiation. The patient received neoadjuvant treatment. Nonetheless, after a short period of disease stabilization, he developed progression and brain metastasis. He died 9 months after diagnosis. During the disease course, his β-human chorionic gonadotropin level was measured repeatedly and analyzed in relation to disease progression. The level of serum β-human chorionic gonadotropin corresponded with the therapy response; it was at its lowest during stabilization and the highest in the metastatic stage. Conclusion Our case study provides the first report of urothelial cancer of the prostate, with a concomitant increase of β-subunit human chorionic gonadotropin level with testis enlargement. Besides its rarity, it constitutes an interesting observation of increasing β-subunit human chorionic gonadotropin concentration with concomitant disease progression.

Characteristics and survival of primary urothelial carcinoma of the prostate: A multi-center retrospective study of 18 cases

“…Most of the symptoms of PUCP are non-specific lower urinary tract symptoms, including dysuria, urinary frequency, nocturia, and pain on urination [ 10 , [15] , [16] , [17] , [18] ]. Gross hematuria can also occur [ 2 , 9 , 16 , 17 ].…”

“…Most of the symptoms of PUCP are non-specific lower urinary tract symptoms, including dysuria, urinary frequency, nocturia, and pain on urination [ 10 , [15] , [16] , [17] , [18] ]. Gross hematuria can also occur [ 2 , 9 , 16 , 17 ]. In our cohort, the most common symptoms of PUCP were dysuria and urinary frequency (77.8 %), followed by gross hematuria (38.9 %) and pain on urination (33.3 %).…”

“…In the case of PUCP, the findings are conflicting. Some studies have reported that PUCP patients have normal serum PSA concentrations [ 2 , 10 , 15 , 16 , 18 , 23 ], whereas others have found high serum PSA concentrations in patients with PUCP [ 8 , 9 , 17 , 19 ]. Only two (11.1 %) patients in our study had high serum total PSA concentrations and no patient had elevated PSA density, which is remarkably different from the findings in patients with prostatic adenocarcinoma.…”

“…Besides, Sołek et al . identified a PUCP patient with high β-human chorionic gonadotropin concentrations [16] . Dong et al.…”