Primary resection of oligometastatic recurrent prostatic carcinoma in the urethra

A man in his 70s presented to the emergency department with acute urinary retention following a 2-day history of gross haematuria with blood clots. He had a significant medical history of intermediate-risk prostate adenocarcinoma (grade group 2, prostate-specific antigen (PSA) 14.9 ng/mL) for which he underwent a robotic-assisted laparoscopic radical prostatectomy (RARP) 13 years ago. PSA nadir was achieved (<0.03 ng/mL). Three years after RARP, he had biochemical recurrence with PSA rising to 0.06 ng/mL. Salvage radiotherapy was performed with good PSA response back to nadir. Workup for gross haematuria included a flexible cystoscopy which revealed a lobulated fleshy lesion occupying the mid-penile urethra. Staging imaging showed no local recurrence at prostatectomy site or lymphadenopathy. PSA was 4.2 ng/mL. Surgical resection with primary repair of the urethra was performed. Postoperative recovery was good with PSA achieving nadir. Histology revealed an upgraded metastatic prostate adenocarcinoma, grade group 5.