What question did this study set out to answer?

To present a rare case of prostate cancer with normal PSA levels and significant bladder outlet obstruction.

May 16, 2026Open Access

Low PSA but high-grade prostate cancer presenting as a bladder-neck mass in a young patient with refractory bladder outlet obstruction

Key Points

To present a rare case of prostate cancer with normal PSA levels and significant bladder outlet obstruction.
Uroflowmetry assessed bladder function, revealing significant obstruction (Qmax 8 mL/s).
Cystoscopy identified and resected a 2 cm bladder-neck mass due to suspected benign obstruction.
Histopathology confirmed prostatic adenocarcinoma with Gleason score 5+4=9; imaging modalities including multiparametric MRI and PSMA PET-CT were utilized.
Histopathology confirmed adenocarcinoma with a high Gleason score (5+4=9).
Multiparametric MRI showed a PI-RADS 4 lesion and PSMA PET-CT indicated no metastasis.
The case emphasizes the need to investigate potential malignancy despite normal PSA levels.

Abstract

Prostate cancer most commonly originates from the peripheral zone and is typically detected by elevated prostate-specific antigen (PSA) levels. We present a 42-year-old man with progressive lower urinary tract symptoms and a PSA level within the normal range (1.45 ng/mL). Uroflowmetry demonstrated significant bladder outlet obstruction (Qmax 8 mL/s). Cystoscopy revealed a 2 cm bladder-neck mass, which was resected transurethrally. Histopathology confirmed prostatic adenocarcinoma with a Gleason score of 5+4=9. Multiparametric MRI showed a PI-RADS 4 lesion, and PSMA PET-CT demonstrated no metastasis. This case highlights that aggressive prostate cancer may present with normal PSA and mimic benign obstruction .

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Cite This Study

Efendioğlu et al. (Fri,) studied this question.

synapsesocial.com/papers/6a080af2a487c87a6a40d020 https://doi.org/https://doi.org/10.1016/j.eucr.2026.103479

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