Villous Adenoma of the Prostate Coexisting with Ductal Adenocarcinoma: Clinical Features, Diagnosis, and Treatment Strategies

In the realm of urological oncology, the coexistence of primary prostatic villous adenoma (PVA) and prostatic ductal adenocarcinoma (PDA) is an extremely rare occurrence, presenting a significant diagnostic and therapeutic conundrum. This case report is of particular interest as it details a unique instance of this dual diagnosis, which is novel due to the scarcity of such cases in the existing literature and the complex molecular characteristics associated with it. The patient was a 79-year-old male with a decade-long history of worsening urinary difficulties. Initially misdiagnosed as benign prostatic hyperplasia based on a normal serum prostate-specific antigen (PSA) level, he underwent transurethral resection of the prostate. This procedure revealed a villous mass, leading to a diagnosis of PVA. Further investigation through radical prostatectomy uncovered coexisting PDA with a high Gleason score, indicating aggressive malignancy. The patient received surgical treatment and showed uneventful recovery with no recurrence within one year of follow-up. Conclusion: This case emphasizes the importance of comprehensive diagnostic approaches in patients with refractory urinary symptoms, as relying solely on traditional markers like PSA can be misleading. It also highlights the need for further research to better understand the relationship between these two rare tumors, develop more accurate diagnostic methods, and establish optimal treatment strategies for such complex cases.