Case Report: Prostatic infarction mimicking prostate cancer in a patient with markedly elevated prostate-specific...

Prostatic infarction is an uncommon benign ischemic lesion that may closely mimic prostate cancer through marked prostate-specific antigen (PSA) elevation and focal prostate abnormalities. A 69-year-old man with long-standing hypertension presented with progressive lower urinary tract symptoms and urinary retention. Pre-catheterization postvoid residual urine volume was approximately 430 mL. Total PSA was 31.858 ng/mL, free PSA was 1.291 ng/mL, and the free-to-total PSA ratio was 0.04. Magnetic resonance imaging revealed a well-circumscribed left transition-zone nodule with a Prostate Imaging Reporting and Data System (PI-RADS) score of 1, whereas contrast-enhanced ultrasound demonstrated a focal perfusion defect. Transperineal systematic biopsy with CEUS-guided targeted sampling and subsequent transurethral resection confirmed focal prostatic infarction with benign prostatic hyperplasia and basal cell hyperplasia, without adenocarcinoma. PSA decreased to 2.34 ng/mL at 1 month, remained low at 2.45 ng/mL at 3 months, and was 1.234 ng/mL approximately 16 months after TURP. This case highlights that prostatic infarction, although uncommon, may contribute to marked PSA elevation and mimic prostate cancer. In patients with high PSA levels and discordant biochemical and imaging findings, prostatic infarction should be considered as a benign differential diagnosis alongside BPH, prostatitis, prostatic abscess, and other non-malignant causes.