Concurrent Jackstone Calculus and Prostate Cancer: Should They Be Treated Concurrently or Sequentially?

Jackstone calculus is a rare urinary stone morphology with a distinctive spiculated appearance, most often reported in the bladder and usually associated with urinary stasis or outlet obstruction. We report a 70-year-old man with 1 year of progressive dysuria and intermittent interruption of urinary stream despite tamsulosin and finasteride. Urinalysis showed pyuria, hematuria, and bacteriuria. Ultrasonography and pelvic computed tomography identified an irregular star-shaped bladder stone and marked prostatic enlargement, with an estimated prostate volume of approximately 125 mL on ultrasonography. Serum total prostate-specific antigen was 16.2 ng/mL, with a free-to-total ratio of 0.138. Systematic transrectal biopsy showed adenocarcinoma in 2 of 12 cores, Gleason score 3 + 3 = 6 (Grade Group 1). After multidisciplinary discussion, the patient underwent laparoscopic radical prostatectomy with concomitant intact stone removal. The 3.1-cm stone showed classic jackstone morphology. Final pathology showed Gleason 3 + 4 = 7 adenocarcinoma (Grade Group 2), upgraded from biopsy, with negative surgical margins. Telephone follow-up at 1, 3, and 12 months showed sustained improvement of lower urinary tract symptoms without recurrent urinary tract infection-related symptoms. Postoperative imaging and prostate-specific antigen data were unavailable. This case is relevant to men's health because a visually distinctive bladder stone may coexist with clinically relevant prostatic disease. In men with lower urinary tract symptoms and abnormal prostate-specific antigen values, bladder outlet obstruction, infection, or bladder stones should not preclude further oncologic evaluation. In selected patients in whom definitive prostate surgery is chosen, combined stone removal can be a practical single-stage approach.