Primary prostatic urothelial carcinoma presenting as persistent perirectal abscess

Primary prostatic urothelial carcinoma is a rare, often asymptomatic, disease. A 62-year-old male presented with chronic, clear fluid leakage from a perirectal abscess and recurrent pelvic fluid collections involving the prostate, penis, scrotum, and perirectal space. No fistulas were identified on surgical exploration and cystogram, and no masses or lesions were seen on CT or cystourethroscopy. Delayed presentation of pelvic lymph node metastatic disease led to the diagnosis of primary prostatic urothelial carcinoma. This is a compelling and educational case that emphasizes the need for oncologic vigilance in patients with persistent, unexplained pelvic or perineal fluid collections and fistula.