A Rare Case of Cystic Prostatic Carcinoma in a Patient From Vietnam

Cystic prostatic carcinoma is a rare and aggressive variant of prostate adenocarcinoma characterized by cystic degeneration within the tumor. Due to its infrequency, clinical data regarding its presentation, optimal management, and prognosis remain limited. We report a case of a 66-year-old male who presented with a two-month history of dysuria and, more recently, hematuria. Imaging studies, including multislice computed tomography and magnetic resonance imaging, revealed a large tumor originating from the prostate, with extensive invasion into the bladder and associated bilateral hydronephrosis. Histopathological analysis confirmed cystic prostatic carcinoma, with a Gleason score of 9 (4+5) and an International Society of Urological Pathology (ISUP) grade group 5, indicating a high-grade malignancy. Given the tumor's extensive local invasion and associated obstructive uropathy, radical surgical intervention was not feasible. A percutaneous nephrostomy was performed for palliative urinary diversion. Despite intervention, the disease progressed rapidly, and the patient succumbed to the illness six months after diagnosis. This report underscores the aggressive nature of cystic prostatic carcinoma, which often presents with rapid progression, local invasion, and poor prognosis. Imaging and pathology are critical for distinguishing it from benign cystic lesions of the prostate, as delayed or inaccurate diagnosis can impede timely management. The presence of bilateral hydronephrosis may indicate advanced disease and has been associated with adverse outcomes in other urological cancers. Due to the scarcity of standardized treatment protocols, management is frequently individualized, and the effectiveness of androgen deprivation therapy or chemotherapy remains uncertain. Further research into molecular characterization and targeted therapies is necessary to improve outcomes for patients with this rare malignancy.