Central European Journal of Urology 26

A 65–year–old Caucasian male presented with lower urinary tract symptoms and a PSA level of 84.5 ng/ mL. A diagnosis of Gleason 4+5 adenocarcinoma of the prostate (Figure 1) was made on biopsies. He had a positive bone scan and was placed on LHRH analogue leuprorelin. He achieved a PSA nadir of 0.4 ng/mL. Two years later he underwent transurethral resec-tion of the prostate for worsening lower urinary tract symptoms. There was a wide–spread necrotic tu-mour extending from the verumontanum proximally involving the bladder neck, trigone and both ureteric orifices. Histopathology confirmed widespread infil-tration of more than 90 % of the chips with moderate to poorly differentiated keratinising squamous cell carcinoma (SCC) (Figure 2). There was no evidence of adenocarcinoma in the prostate chips this time. His new CT and bone scans restaged the disease a