A hen’s tooth in the prostate

This case report demonstrates an interesting and rare form of prostate cancer. It outlines the presenting symptoms and the subsequent management of such a rare and malignant prostatic cancer. Of note is the prostate-specific antigen (PSA) within normal range at the time of presentation. The cancer was advanced at first presentation to our Service. Case report A previously healthy 56-year-old white male presented with a 3-week history of lower abdominal pain. Physical examination revealed a large mass in what was thought to be the anterior rectal region. He had no lower urinary tract symptoms. PSA=1.8 mg/L. Colonoscopy demonstrated indentation in the middle third of the rectum anteriorly with an intact overlying mucosa. Abdominal and pelvic computed tomography (CT) scan demonstrated a large soft tissue mass in the pelvic cavity with pararectal lymphadenopathy. Transrectal ultrasound guided biopsy revealed malignant spindle cells in all cores with foci of adenocarcinoma, designated Gleason 3+3. Based on the histology from the transrectal biopsy findings and the radiologica