[Prostatic leiomyoma]

Prostatic leiomyoma is a rare benign mesenchymal tumor arising from the smooth muscle fibers of the prostatic stroma. Clinically, it may mimic benign prostatic hyperplasia or a malignant lesion, which makes preoperative diagnosis difficult. We present a clinical case of a 52-year-old patient with severe lower urinary tract symptoms and a normal prostate-specific antigen level (0.65 ng/mL) who was diagnosed with prostatic leiomyoma complicated by significant bladder outlet obstruction. We also analyze the diagnostic and surgical aspects of the management of this disease. According to the diagnostic work-up, including ultrasonography, magnetic resonance imaging, and uroflowmetry, a prostatic mass classified as PI-RADS 2 was identified. After prostate biopsy, laser enucleation was performed. Due to the high tissue density, conversion to transvesical removal of the enucleated prostatic lobes was required. Histological examination confirmed the diagnosis of prostatic leiomyoma.

Prostatic leiomyoma is one of the rarest benign mesenchymal tumors encountered in urological practice. Typical manifestations include symptoms of bladder outlet obstruction in the presence of a normal PSA level; nevertheless, differential diagnosis with prostate cancer remains mandatory. Since no standard treatment strategy for prostatic leiomyoma has been established, management should be individualized, taking into account tumor size, symptom severity, and the patients overall somatic status.