Prostate cancer misdiagnosed as prostatic abscess: case report and literature review

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However, due to multiple challenges in diagnostic techniques and clinical practice, cases of missed diagnosis and misdiagnosis still persist. Case presentation This article presents a case of a 36-year-old male patient who had undergone kidney transplantation. Initially, he was misdiagnosed with a prostatic abscess (PA) due to symptoms such as perineal heaviness and mild tenesmus. However, the diagnosis was later confirmed as PCa through surgical intervention. Conclusions This case highlights the similarities in symptoms and imaging manifestations between PCa and PA, as well as the complexity involved in diagnosing PCa. Furthermore, it underscores the significance for clinicians to rationally utilize clinical examination methods, remain vigilant about the heightened risk of malignancies following kidney transplantation, and enhance their ability to differentiate and diagnose prostate cancer. These efforts contribute to accumulating experience for the early diagnosis of PCa. Prostate cancer Prostatic abscess Misdiagnosis Diagnosis Case report Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1 Background Prostate cancer (PCa) is the most common malignant tumor in the male genitourinary system. According to the latest GLOBOCAN statistics from the World Health Organization in 2018, PCa ranks second in terms of incidence among male malignancies worldwide, second only to lung cancer, and is also the fifth leading cause of cancer-related deaths [1] .With global aging and the continuous increase in life expectancy, the burden of PCa on public healthcare systems in various countries will keep rising. PCa typically manifests with urinary symptoms, such as frequency, urgency, nocturia, and hematuria. In the advanced stages of disease progression, patients may present with perineal distension and tenesmus. These symptoms partially overlap with those of conditions such as prostatitis and PA, which often leads to frequent missed diagnoses and misdiagnoses [2] . Consequently, this delays the treatment of patients, adversely affecting their prognosis. Here, we report on a 36-year-old patient who had undergone kidney transplantation and experienced perineal pain for nearly one year. Preoperative multiple imaging examinations indicated PA, but postoperative pathology confirmed PCa. The clinical details of this rare case highlight the significance of considering PCa in the differential diagnosis of prostatic lesions among young patients. 2 Case presentation A 36-year-old male patient presented to the hospital 8 months ago due to 7 months of recurrent, which had worsened over the past 2 days. The patient underwent a kidney transplant 15 years ago. After admission, the patient's body temperature was 37.2°C. A tender spot was palpable at the 11 o'clock position in the lithotomy position during digital rectal examination (DRE). Blood tests showed a white blood cell (WBC) count of 11.9×10^9/L, a C-reactive protein (CRP) level of 10.4 mg/L, a total prostate-specific antigen (tPSA) level of 4.53 ng/mL, and a serum creatinine (SCr) level of 121 µmol/L. Magnetic resonance imaging (MRI) of anal canal examination revealed abnormal signal foci in the prostate involving the seminal vesicles and rectum (Fig. 1 A-C). Contrast-enhanced ultrasound (CEUS) suggested an unliquefied PA (Fig. 2 ). Based on a comprehensive evaluation of the aforementioned clinical symptoms and examination results, the patient's preliminary diagnoses were: (1) Prostatic abscess; (2) Renal allograft dysfunction. The differential diagnoses were: (1) PCa ; (2) Prostatic sarcoma. Subsequently, the patient was administered cefoperazone-sulbactam 1.5 g every 12 hours via intravenous drip for anti-infective therapy, along with tamsulosin hydrochloride sustained-release capsules to alleviate symptoms. One week later, the patient's symptoms had alleviated. The patient came to the hospital 10 days ago due to recurrent perineal pain. Blood tests revealed a WBC count of 6.3×10⁹/L, CRP level of 5.9 mg/L, a tPSA level of 7.29 ng/mL, and a SCr level of 144 µmol/L. Urine culture indicated a positive result for candida glabrata. Multiparametric magnetic resonance imaging (Mp-MRI) demonstrated an enlargement of the lesion size compared to previous images (Fig. 3 A, B), along with the presence of several newly enlarged lymph nodes beside the bilateral iliac vessels, indicating a high probability of PCa (Fig. 3 C). The patient underwent a laparoscopic radical prostatectomy on February 26, 2025. During the surgery, it was noted that the prostate was significantly enlarged and had prominent adhesion to the bladder neck, and an enlarged lymph node approximately 2 cm in size was observed adjacent to the left iliac vessel. The postoperative pathological histological type was identified as poorly differentiated prostate adenocarcinoma with necrosis, involving 90% of the total prostate volume (Fig. 4 ). Extraprostatic extension : (+), surgical margin of the specimen (prostatic dissection surface) : (+). Intravascular tumor emboli: (+), perineural invasion : (+). No cancer metastasis was observed in the prefatty tissue of the prostate: (0/2), metastasis was found in the lymph node adjacent to the left iliac vessel: (1/1). The pTNM staging (AJCC 8th) is pT4N1Mx. Immunohistochemistry results: For marker B: NKX3.1 (+), P504S (+), SMA (-), CD56 (-), AR (+). For marker R: S-100 (-), Ki-67 (+) 60%, CK (pan) (+), Syn (-), CD56 (-), CgA (-). For marker V༚INSM1 (-), CD34 (-), MPO (-), WT-1 (-). Discharge Diagnoses: (1)Prostate cancer, (2) Renal allograft dysfunction. Detailed examination procedures are illustrated in the accompanying Fig. 5 . 3 Discussion PCa as one of the most prevalent types of cancer among men, is posing a severe threat to the health of men worldwide. The establishment of a comprehensive diagnostic system for PCa facilitates early detection and timely treatment, thereby effectively enhancing progression-free survival. By conducting a comprehensive analysis of the clinical data provided in this case study, we have attributed the causes of misdiagnosis to the following factors. Initially, the patient's clinical symptoms, including low-grade fever, perineal heaviness, and urinary tract infections, were highly similar to those of a PA. Coupled with the patient's young age and immunosuppression due to long-term use of anti-rejection medications, clinicians considered a high likelihood of infection. Moreover, after the initial treatment, the patient reported an improvement in symptoms, which seemed to confirm the diagnosis of a PA. Secondly, the patient's laboratory results lacked typicality. Inflammatory markers such as CRP and WBC count were partially elevated. In two PSA tests, the tPSA levels fell within the gray zone (4-10 ng/mL) , while the ratios of free PSA (fPSA) to tPSA remained normal. Additionally, the urine culture yielded positive results, all of which, to a certain extent, interfered with clinical judgment. Thirdly, MRI and CEUS failed to fully demonstrate their diagnostic utility in this case. From an imaging perspective, the lesion exhibited extensive involvement, with no significant signal restriction observed on the diffusion-weighted imaging (DWI) sequence, and lacked a prominent mass effect. Ultrasound imaging is closely associated with the operator's experience and subjectivity, which serves as one of the primary causes of misdiagnosis in this case. Fourthly, following a series of anti-infective and symptomatic interventions administered after the initial hospitalization, the patient reported a discernible alleviation of their clinical symptoms. The follow-up MRI demonstrated a slight reduction in the size of the local lesion, which appeared to corroborate the diagnosis of a PA, ultimately contributing to a delay in the patient's treatment. In clinical settings, when encountering cases with high-risk factors for PCa yet atypical clinical symptoms and imaging manifestations, or when anti-infectious treatment yields prove ineffective, it is imperative to re-evaluate and contemplate conducting PCa screening. To facilitate the achievement of early and accurate diagnosis of PCa, effective information can be obtained through the following clinical approaches. The role of DRE in the diagnosis of PCa: As a simple and cost-effective physical examination method, DRE has an overall accuracy rate of 63.45% [3] . Thus, DRE serves as a convenient screening method for PCa, necessitating further investigations to confirm or rule out PCa. The role of biomarkers in the diagnosis of PCa: PSA is currently the most widely used biomarker for PCa diagnosis. However, its limited specificity and the resulting overtreatment remain its drawbacks, which compel people to search for biomarkers with heightened predictive potential for PCa. The 4-Kallikrein score (4Kscore) comprises four kallikrein proteins, namely human kallikrein 2 (HK2), intact prostate-specific antigen (iPSA), free prostate-specific antigen (fPSA), and total prostate-specific antigen (tPSA) [4] . It combines the measurements of four biomarkers with clinical data (including age, DRE results, and history of negative biopsies) to predict the risk of aggressive tumors.The Prostate Health Index (PHI) integrates three major indicators, namely p2PSA, tPSA and fPSA. It maintains high sensitivity while increasing the specificity to 42% [5] . When circulating tumor cells (CTC) are integrated with PSA testing or other pertinent assays, they can attain a predictive accuracy of 90% for PCa [6] .Therefore, the integration of multiple biomarkers is an indispensable component for enhancing the diagnostic accuracy of PCa. 3. The role of MRI in the diagnosis of PCa: As the gold-standard imaging technique for staging and localizing PCa lesions, Mp-MRI demonstrates an overall sensitivity of 0.74 and specificity of 0.88 [7] .This technique spares 27% of patients from undergoing prostate biopsy [8] . Mp-MRI is composed of high-resolution T2WI, DWI, and dynamic contrast-enhanced (DCE) sequences. The Prostate Imaging Reporting and Data System (PI-RADS) based on Mp-MRI demonstrates a relatively high diagnostic accuracy for clinically significant prostate cancer (csPCa). In recent years, Bp-MRI which includes both T2WI and DWI sequences, has been demonstrated to be non-inferior to Mp-MRI, and it offers the advantages of shorter scanning time and eliminates the risks associated with contrast agents [9] . However, no clear consensus has been reached regarding Bp-MRI at present. 4. The role of ultrasound in the diagnosis of PCa: Transrectal ultrasonography (TRUS), a commonly used imaging modality in urology, now plays a guiding role during prostate biopsy and treatment. CEUS can serve as an effective complementary tool for Bp-MRI in the diagnosis of PCa. The combined use of these two modalities contributes to improving diagnostic accuracy, particularly in patients with renal insufficiency or those allergic to gadolinium-based contrast agents [10] . Ultrasound elastography (UE) quantitatively reflects the stiffness of focal tissues, demonstrating higher accuracy in detecting aggressive lesions [11] . However, ultrasound examination is susceptible to the operator’s proficiency and subjective factors, which may introduce bias into the examination results. 5. The role of PET/CT in the diagnosis of PCa: Prostate-specific membrane antigen (PSMA) PET/CT reflects the physiological metabolism of tissues. Compared with traditional imaging modalities, it exhibits greater specificity in the detection of pelvic lymph node metastases or distant metastases [12,13] . Previous research has indicated that the maximum standardized uptake value (SUVmax) on PSMA PET/CT is significantly correlated with PSMA expression levels, Gleason scores, and tumor aggressiveness. Consequently, it can serve as a crucial biomarker for distinguishing clinically significant prostate cancer from benign prostatic diseases [14] . However, false-positive results may occur due to the high affinity of the ribs and pelvic bones for radiolabeled agents. Consequently, it is essential to incorporate additional diagnostic examinations to ascertain the presence or absence of bone metastases. 6. The role of Artificial Intelligence (AI) in the diagnosis of PCa: With the continuous advancement of AI within the field of modern medicine, the application of AI in the diagnosis, differentiation, and evaluation of PCa demonstrates both feasibility and significant clinical applicability [15,16] . However, when compared with traditional inspection approaches, the accuracy and interpretability of this method still necessitate extensive clinical trials for validation. It is noteworthy that the use of immunosuppressants after kidney transplantation has been proven to increase the risk of developing malignancies and infections. Among these, the occurrence of malignancies post-transplantation ranks as the third most common cause of death in transplant recipients. Notably, Kaposi's sarcoma, lymphoma, and non-melanoma skin cancer exhibit the highest incidence rates among these malignancies [17] . It is estimated that the overall risk of developing malignancies in kidney transplant recipients is approximately three times higher than that in the general population. The risk of malignancy after a decade of long-term immunosuppressive therapy is about 20% , and it increases to approximately 30% after 20 years. The risk of malignancy in this patient population varies by cancer type, ranging from 1.3 times higher (for breast cancer) to 250 times higher (for cutaneous squamous cell carcinoma) compared to the general population [18] . However, some scholars have also proposed that the incidence of cancers that are relatively common in the general population (such as breast cancer, prostate cancer, and lung cancer) is comparable among kidney transplant recipients [19] . Additionally, PSA is not exclusive to cancer; elevated PSA levels can also be caused by benign prostatic hyperplasia, and prostatitis. However, in this case, despite appropriate antibiotic treatment leading to an improvement in inflammatory markers, the PSA levels gradually increased, suggesting a high likelihood of tumor development. Since the advent of antibiotics, the incidence of PA has been continuously declining, accounting for approximately 0.5% of all urinary system diseases, with a higher prevalence among patients with diabetes and those with compromised immune function [20] . Symptoms of PA overlap with those of other urinary system diseases. Its characteristic sign is tenderness upon palpation in the prostatic region during DRE. However, studies have indicated that only 52.2% of PA patients exhibit positive DRE findings [21] . It is challenging to differentiate between PA and PCa based solely on medical history and physical examination. Mp-MRI plays a pivotal role in the diagnostic process of PA. The MRI manifestations of PA are largely dependent on the structures within the abscess wall and the abscess cavity. DCE-MRI imaging can reveal significant enhancement of the abscess wall with no enhancement in the abscess cavity, whereas entire lesion of PCa exhibits pronounced and homogeneous enhancement. Given the distinct pathological foundations and varying degrees of water molecule diffusion between PCa and PA, these differences manifest as signal variations on DWI and ADC maps. In PCa, restricted diffusion of tumor molecules is attributed to compression of the extracellular space, whereas in PA, the restricted diffusion of water molecules within the abscess cavity arises from an expansion of the extracellular space. Consequently, the degree of diffusion restriction is lower in PCa than in PA, and the ADC values of PCa are higher than those of PA [22] . Therefore, DWI sequence exhibits high sensitivity in detecting minute abscesses. In this case, the enhanced appearance of the region with restricted diffusion on DWI is clearly inconsistent with the typical imaging manifestations of PA. Furthermore, PCa tissue generally presents as uniformly hypointense on T2WI, while PA often shows hyperintensity on T2WI due to intracavitary liquefactive necrosis. These imaging features can also serve as distinguishing points between the two conditions. 4 Conclusion The misdiagnosis of PCa is influenced by multiple factors: insufficient specificity of prostate cancer-related biomarker tests, atypical imaging signs, and insufficient understanding among clinicians about PCa. Meanwhile, comorbidities in patients themselves also interfere with the diagnostic accuracy to a certain extent. To address the above issues, it is necessary to construct a multimodal diagnostic system, integrate multiple examination techniques, and strengthen the training of clinicians on complex PCa, so as to improve the diagnostic accuracy. Abbreviations PCa Prostate cancer PA Prostatic abscess Mp-MRI Multiparametric magnetic resonance imaging DCE-MRI Dynamic contrast-enhanced magnetic resonance imaging PSA Prostate specific antigen Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Ningbo Yinzhou NO.2 Hospital. In addition, informed consent was taken from the patient. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Competing interests The authors declare no competing interests. Funding This research received no external funding. Author Contribution All authors contributed to the study conception and design. Material preparation and data collection were performed by Y W, and analysis were performed by J W. The first draft of the manuscript was written by Y W and all authors commented on previous versions of the manuscript. Acknowledgement This work was supported by the radiology departments of Ningbo Yinzhou NO.2 Hospital, China, which provided comprehensive help. In addition, we are very grateful to my colleagues and friends for their contributions to this paper. Data Availability All data generated or analysed during this study are included in this published article. References Mo Q, Wang F, Liang H, Li Y, Qin M, et al. Tracking and analysis of benign prostatic hyperplasia and prostate cancer burden globally: 1990-2021 epidemiological trends. Transl Androl Urol . (2025) 14: 764-778. DOI: 10.21037/tau-2025-12. Adam S, Jessica B, F. M A, et al. Case of the month from the Thomas Jefferson Sidney Kimmel medical college, Philadelphia, USA. Prostatic abscess and advanced prostate cancer: considering malignancy in the differential diagnosis. BJU Int . (2022) 130: 181-185. DOI: 10.1111/BJU.1573. Ying Y, He W, Xiong Q, Wang Z, Wang M, et al. Value of digital rectal examination in patients with suspected prostate cancer: a prospective cohort analysis study. Transl Androl Urol . (2023) 12: 1666-1672. DOI: 10.21037/tau-23-371. Boehm B E, York M E, Petrovics G, Kohaar I, Chesnut G T. Biomarkers of Aggressive Prostate Cancer at Diagnosis. Int J Mol Sci . (2023) 24:2185-2185. DOI:10.3390/ijms24032185. Ito K, Yokomizo A, Tokunaga S, Arai G, Sugimoto M, et al. Diagnostic Impacts of Clinical Laboratory Based p2PSA Indexes on any Grade, Gleason Grade Group 2 or Greater, or 3 or Greater Prostate Cancer and Prostate Specific Antigen below 10 ng/ml. J Urol . (2020) 203: 83-91. DOI: 10.1097/JU.0000000000000495. Zhenrong Y, Hongsong B, Linjun H, et al. 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(2023) 13:1275773-1275773. DOI: 10.3389/fonc.2023.1275773. Hu, Q, Cheng S, Yuan C, Jin C. Recent Research Advances in Imaging of Prostate Cancer. JBM . (2024) 12 : 114-128. DOI: 10.4236/jbm.2024.126012. Shen Z, Li Z, Li Y, Tang X, Lu J, et al. PSMA PET/CT for prostate cancer diagnosis: current applications and future directions. J Cancer Res Clin Oncol . (2025) 151:155-155. DOI: 10.1007/s00432-025-06184-z. Mingels C, Loebelenz L I, Huber A T, Alberts I, Rominger A, Afshar-Oromieh A, Obmann V C. Literature review: Imaging in prostate cancer. Curr Probl Cancer. (2023) 47:100968-100968. DOI: 10.1016/j.currproblcancer.2023.100968. Jiao J, Kang F, Zhang J, et al. Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by 68 Ga-PSMA PET/CT: a real-world study. Theranostics . (2021) 11:8396-8411. DOI：10.7150/THNO.58140. Roest C, Kwee TC, de Jong IJ, Schoots IG, van Leeuwen P, Heijmink SWTPJ, et al. Development and Validation of a Deep Learning Model Based on MRI and Clinical Characteristics to Predict Risk of Prostate Cancer Progression. Radiol Imaging Cancer . (2025) 7: e240078. DOI: 10.1148/rycan.240078. . Chen T, Hu W, Zhang Y, Wei C, Zhao W, Shen X, Zhang C, Shen J. A Multimodal Deep Learning Nomogram for the Identification of Clinically Significant Prostate Cancer in Patients with Gray-Zone PSA Levels: Comparison with Clinical and Radiomics Models. Acad Radiol . (2025) 32: 864-876. DOI: 10.1016/j.acra.2024.10.009. Nabi Z, Zahid T, Nabi R. Post Renal Transplant Malignancies; A Basic Concept. J Ayub Med Coll Abbottabad . (2023) 35: 664-668. DOI: 10.55519/JAMC-04-12230. Ciesielski W, Frąk W, Gmitrzuk J, Kuczyński P, Klimczak T, et al. The assesement of the long-term effects of kidney transplantation, including the incidence of malignant tumors, in recipients operated on between 2006 and 2015 - a cohort study and literature review. Pol Przegl Chir . (2025) 97: 1-9. DOI: 10.5604/01.3001.0054.9677. Medeiros E, Merhi B. Malignancy After Renal Transplantation: A Review. R I Med J (2013) . (2021) 104: 25-30. PMID: 33517595. Wettstein J, Lynch W, Graham M B. Prostatic Abscess Presenting as Penile Discharge: A Case Report. WMJ. (2025) 124: 69-70. PMID: 40262012 Sakakiyama M, Hayashi K, Tada M, Hayashi M, Nakaya Y, et al. Prostatic Abscess by Morganella morganii. Cureus . (2025) 17: e86265. DOI: 10.7759/cureus.86265. Ren J , Huang X , Wang H , et al. Prostatic abscess and seminal vesicle abscess: MRI findings and quantitative analysis of apparent diffusion coefficient values. Radiol Infect Dis . (2015) 2: 27-32. DOI: 10.1016/j.jrid.2015.04.003. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7377880","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":512253660,"identity":"b2e24d27-0943-4391-af57-6452119ba79b","order_by":0,"name":"Yannan Wang","email":"","orcid":"","institution":"Ningbo Yinzhou No.2 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yannan","middleName":"","lastName":"Wang","suffix":""},{"id":512253661,"identity":"f5afb259-84b0-42e6-99f9-6d8e5c280229","order_by":1,"name":"Junguang Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYHCCBCjNfODAhx9EqOdBaGFLPDizhzgtcKbxYQ42IrTY8x94Jl3w67C8Of+aD4eBJsjzix0gYItEQpr0zL7DhjtnvN1wuMCCwXDm7ARCWhjSpHl7DjNuuHF2w+EZPAwJBrcJaeE/ANZiv+HGmQeHediI0cIAdBjPj8OJG873MBCp5UZCsjVvQ3ryhhtsBsBAliDsF/b+M4m3ef5Y2244f/jxhw8/bOT5pQloAdqTwMDYBqQlwColCCkH23OAgeEPkOY/QIzqUTAKRsEoGIkAAHevSYINay9RAAAAAElFTkSuQmCC","orcid":"","institution":"Ningbo Yinzhou No.2 Hospital","correspondingAuthor":true,"prefix":"","firstName":"Junguang","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-08-15 03:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7377880/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7377880/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12894-025-01982-6","type":"published","date":"2025-11-18T15:58:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91073096,"identity":"446bd1e1-7582-40d1-b759-365fd57692c7","added_by":"auto","created_at":"2025-09-11 10:57:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":156525,"visible":true,"origin":"","legend":"\u003cp\u003eThe boundary between the lesion and the posterior wall of the rectum is indistinct, with mixed signal intensity on T2WI-FS images (A). There is no obvious restricted diffusion (B), and patchy enhancement is observed within this region (red arrow, C).\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/0f6efaa41eebcffca846cbcc.png"},{"id":91073098,"identity":"de8081cc-b9a0-4322-859a-1af72748017c","added_by":"auto","created_at":"2025-09-11 10:57:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":147332,"visible":true,"origin":"","legend":"\u003cp\u003eCUES reveals an inhomogeneous hypoechoic mass in the right lateral glandular region of the prostate (white arrow). After contrast agent injection, no significant contrast agent filling is observed in this region .\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/1f7abb568f223f957d2b2e5f.png"},{"id":91073100,"identity":"fbe7d721-a7e5-40eb-bc5d-393b5072970a","added_by":"auto","created_at":"2025-09-11 10:57:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":168779,"visible":true,"origin":"","legend":"\u003cp\u003eMP-MRI examination indicates an enlargement of the lesion scope compared to the previous scan (A), with pronounced diffusion restriction (white triangle, B). Enlarged lymph nodes are observed adjacent to the left iliac vessels (white arrow, C). The red arrow points to the transplanted kidney.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/4c7f093dfb2c03a51145d6a5.png"},{"id":91076907,"identity":"a08770ce-92da-4596-9e5e-d26ebfa74a7a","added_by":"auto","created_at":"2025-09-11 11:13:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":257595,"visible":true,"origin":"","legend":"\u003cp\u003eHistopathology: \u0026nbsp;Poorly differentiated Prostatic Adenocarcinoma (HE×100)\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/973ecc9d21e636ee2c368825.png"},{"id":91074962,"identity":"537a477a-7345-45e6-81a8-b39483452609","added_by":"auto","created_at":"2025-09-11 11:05:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":136510,"visible":true,"origin":"","legend":"\u003cp\u003eThe course of diagnosis and treatment\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/67c7d097b5351ddeaf293f37.png"},{"id":96650210,"identity":"6ee7d379-63e6-4546-904e-849d953d0c3c","added_by":"auto","created_at":"2025-11-24 16:09:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1336332,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7377880/v1/e59a9d62-2f83-4265-98f6-9e394d9c0338.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prostate cancer misdiagnosed as prostatic abscess: case report and literature review","fulltext":[{"header":"1 Background","content":"\u003cp\u003eProstate cancer (PCa) is the most common malignant tumor in the male genitourinary system. According to the latest GLOBOCAN statistics from the World Health Organization in 2018, PCa ranks second in terms of incidence among male malignancies worldwide, second only to lung cancer, and is also the fifth leading cause of cancer-related deaths\u003csup\u003e[1]\u003c/sup\u003e.With global aging and the continuous increase in life expectancy, the burden of PCa on public healthcare systems in various countries will keep rising. PCa typically manifests with urinary symptoms, such as frequency, urgency, nocturia, and hematuria. In the advanced stages of disease progression, patients may present with perineal distension and tenesmus. These symptoms partially overlap with those of conditions such as prostatitis and PA, which often leads to frequent missed diagnoses and misdiagnoses\u003csup\u003e[2]\u003c/sup\u003e. Consequently, this delays the treatment of patients, adversely affecting their prognosis.\u003c/p\u003e\u003cp\u003eHere, we report on a 36-year-old patient who had undergone kidney transplantation and experienced perineal pain for nearly one year. Preoperative multiple imaging examinations indicated PA, but postoperative pathology confirmed PCa. The clinical details of this rare case highlight the significance of considering PCa in the differential diagnosis of prostatic lesions among young patients.\u003c/p\u003e"},{"header":"2 Case presentation","content":"\u003cp\u003eA 36-year-old male patient presented to the hospital 8 months ago due to 7 months of recurrent, which had worsened over the past 2 days. The patient underwent a kidney transplant 15 years ago. After admission, the patient's body temperature was 37.2\u0026deg;C. A tender spot was palpable at the 11 o'clock position in the lithotomy position during digital rectal examination (DRE). Blood tests showed a white blood cell (WBC) count of 11.9\u0026times;10^9/L, a C-reactive protein (CRP) level of 10.4 mg/L, a total prostate-specific antigen (tPSA) level of 4.53 ng/mL, and a serum creatinine (SCr) level of 121 \u0026micro;mol/L. Magnetic resonance imaging (MRI) of anal canal examination revealed abnormal signal foci in the prostate involving the seminal vesicles and rectum (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA-C). Contrast-enhanced ultrasound (CEUS) suggested an unliquefied PA (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Based on a comprehensive evaluation of the aforementioned clinical symptoms and examination results, the patient's preliminary diagnoses were: (1) Prostatic abscess; (2) Renal allograft dysfunction. The differential diagnoses were: (1) PCa ; (2) Prostatic sarcoma. Subsequently, the patient was administered cefoperazone-sulbactam 1.5 g every 12 hours via intravenous drip for anti-infective therapy, along with tamsulosin hydrochloride sustained-release capsules to alleviate symptoms. One week later, the patient's symptoms had alleviated.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe patient came to the hospital 10 days ago due to recurrent perineal pain. Blood tests revealed a WBC count of 6.3\u0026times;10⁹/L, CRP level of 5.9 mg/L, a tPSA level of 7.29 ng/mL, and a SCr level of 144 \u0026micro;mol/L. Urine culture indicated a positive result for candida glabrata. Multiparametric magnetic resonance imaging (Mp-MRI) demonstrated an enlargement of the lesion size compared to previous images (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, B), along with the presence of several newly enlarged lymph nodes beside the bilateral iliac vessels, indicating a high probability of PCa (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eC).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe patient underwent a laparoscopic radical prostatectomy on February 26, 2025. During the surgery, it was noted that the prostate was significantly enlarged and had prominent adhesion to the bladder neck, and an enlarged lymph node approximately 2 cm in size was observed adjacent to the left iliac vessel. The postoperative pathological histological type was identified as poorly differentiated prostate adenocarcinoma with necrosis, involving 90% of the total prostate volume (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Extraprostatic extension : (+), surgical margin of the specimen (prostatic dissection surface) : (+). Intravascular tumor emboli: (+), perineural invasion : (+). No cancer metastasis was observed in the prefatty tissue of the prostate: (0/2), metastasis was found in the lymph node adjacent to the left iliac vessel: (1/1). The pTNM staging (AJCC 8th) is pT4N1Mx. Immunohistochemistry results: For marker B: NKX3.1 (+), P504S (+), SMA (-), CD56 (-), AR (+). For marker R: S-100 (-), Ki-67 (+) 60%, CK (pan) (+), Syn (-), CD56 (-), CgA (-). For marker V༚INSM1 (-), CD34 (-), MPO (-), WT-1 (-). Discharge Diagnoses: (1)Prostate cancer, (2) Renal allograft dysfunction. Detailed examination procedures are illustrated in the accompanying Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"3 Discussion","content":"\u003cp\u003ePCa as one of the most prevalent types of cancer among men, is posing a severe threat to the health of men worldwide. The establishment of a comprehensive diagnostic system for PCa facilitates early detection and timely treatment, thereby effectively enhancing progression-free survival.\u003c/p\u003e\n\u003cp\u003eBy conducting a comprehensive analysis of the clinical data provided in this case study, we have attributed the causes of misdiagnosis to the following factors. Initially, the patient's clinical symptoms, including low-grade fever, perineal heaviness, and urinary tract infections, were highly similar to those of a PA. Coupled with the patient's young age and immunosuppression due to long-term use of anti-rejection medications, clinicians considered a high likelihood of infection. Moreover, after the initial treatment, the patient reported an improvement in symptoms, which seemed to confirm the diagnosis of a PA. Secondly, the patient's laboratory results lacked typicality. Inflammatory markers such as CRP and WBC count were partially elevated. In two PSA tests, the tPSA levels fell within the gray zone (4-10 ng/mL) , while the ratios of free PSA (fPSA) to tPSA remained normal. Additionally, the urine culture yielded positive results, all of which, to a certain extent, interfered with clinical judgment. Thirdly, MRI and CEUS\u0026nbsp;failed to fully demonstrate their diagnostic utility in this case. From an imaging perspective, the lesion exhibited extensive involvement, with no significant signal restriction observed on the diffusion-weighted imaging (DWI) sequence, and lacked a prominent mass effect. Ultrasound imaging is closely associated with the operator's experience and subjectivity, which serves as one of the primary causes of misdiagnosis in this case. Fourthly, following a series of anti-infective and symptomatic interventions administered after the initial hospitalization, the patient reported a discernible alleviation of their clinical symptoms. The follow-up MRI demonstrated a slight reduction in the size of the local lesion, which appeared to corroborate the diagnosis of a PA, ultimately contributing to a delay in the patient's treatment.\u003c/p\u003e\n\u003cp\u003eIn clinical settings, when encountering cases with high-risk factors for PCa yet atypical clinical symptoms and imaging manifestations, or when anti-infectious treatment yields prove ineffective, it is imperative to re-evaluate and contemplate conducting PCa screening. To facilitate the achievement of early and accurate diagnosis of PCa, effective information can be obtained through the following clinical approaches.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe role of DRE in the diagnosis of PCa: As a simple and cost-effective physical examination method, DRE has an overall accuracy rate of 63.45%\u003csup\u003e[3]\u003c/sup\u003e.\u0026nbsp;Thus, DRE serves as a convenient screening method for PCa, necessitating further investigations to confirm or rule out PCa.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe role of biomarkers in the diagnosis of PCa: PSA is currently the most widely used biomarker for PCa diagnosis. However, its limited specificity and the resulting overtreatment remain its drawbacks, which compel people to search for biomarkers with heightened predictive potential for PCa.\u0026nbsp;The 4-Kallikrein score (4Kscore) comprises four kallikrein proteins, namely human kallikrein 2 (HK2), intact prostate-specific antigen (iPSA), free prostate-specific antigen (fPSA), and total prostate-specific antigen (tPSA)\u003csup\u003e[4]\u003c/sup\u003e.\u0026nbsp;It combines the measurements of four biomarkers with clinical data (including age, DRE\u0026nbsp;results, and history of negative biopsies) to predict the risk of aggressive tumors.The Prostate Health Index (PHI) integrates three major indicators, namely p2PSA, tPSA and fPSA. It maintains high sensitivity while increasing the specificity to 42%\u003csup\u003e[5]\u003c/sup\u003e. When circulating tumor cells (CTC) are integrated with PSA testing or other pertinent assays, they can attain a predictive accuracy of 90% for PCa\u003csup\u003e[6]\u003c/sup\u003e.Therefore, the integration of multiple biomarkers is an indispensable component for enhancing the diagnostic accuracy of PCa.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e3.\u0026nbsp;The role of MRI in the diagnosis of PCa: As the gold-standard imaging technique for staging and localizing PCa lesions, Mp-MRI demonstrates an overall sensitivity of 0.74 and specificity of 0.88\u003csup\u003e[7]\u003c/sup\u003e.This technique spares 27% of patients from undergoing prostate biopsy\u003csup\u003e[8]\u003c/sup\u003e.\u0026nbsp;Mp-MRI is composed of high-resolution T2WI, DWI, and dynamic contrast-enhanced (DCE)\u0026nbsp;sequences. The Prostate Imaging Reporting and Data System (PI-RADS) based on\u0026nbsp;Mp-MRI demonstrates a relatively high diagnostic accuracy for clinically significant prostate cancer (csPCa).\u0026nbsp;\u0026nbsp;In recent years,\u0026nbsp;Bp-MRI\u0026nbsp;which includes both T2WI and DWI sequences, has been demonstrated to be non-inferior to\u0026nbsp;Mp-MRI,\u0026nbsp;and it\u0026nbsp;offers the advantages of shorter scanning time and eliminates the risks associated with contrast agents\u003csup\u003e[9]\u003c/sup\u003e.\u0026nbsp;However, no clear consensus has been reached regarding Bp-MRI at present.\u003c/p\u003e\n\u003cp\u003e4. The role of ultrasound in the diagnosis of PCa: Transrectal ultrasonography (TRUS), a commonly used imaging modality in urology, now plays a guiding role during prostate biopsy and treatment. CEUS can serve as an effective complementary tool for Bp-MRI in the diagnosis of PCa. The combined use of these two modalities contributes to improving diagnostic accuracy, particularly in patients with renal insufficiency or those allergic to gadolinium-based contrast agents\u003csup\u003e[10]\u003c/sup\u003e.\u0026nbsp;Ultrasound elastography (UE) quantitatively reflects the stiffness of\u0026nbsp;focal\u0026nbsp;tissues,\u0026nbsp;demonstrating\u0026nbsp;higher accuracy in detecting aggressive lesions\u003csup\u003e[11]\u003c/sup\u003e.\u0026nbsp;However, ultrasound examination is susceptible to the operator’s proficiency and subjective factors, which may introduce bias into the examination results.\u003c/p\u003e\n\u003cp\u003e5. The role of PET/CT in the diagnosis of PCa: Prostate-specific membrane antigen (PSMA) PET/CT reflects the physiological metabolism of tissues. Compared with traditional imaging modalities, it exhibits greater specificity in the detection of pelvic lymph node metastases or distant metastases\u003csup\u003e[12,13]\u003c/sup\u003e.\u0026nbsp;Previous research has indicated that the maximum standardized uptake value (SUVmax) on PSMA PET/CT is significantly correlated with PSMA expression levels, Gleason scores, and tumor aggressiveness. Consequently, it can serve as a crucial biomarker for distinguishing clinically significant prostate cancer\u0026nbsp;from benign prostatic diseases\u003csup\u003e[14]\u003c/sup\u003e. However, false-positive results may occur due to the high affinity of the ribs and pelvic bones for radiolabeled agents. Consequently, it is essential to incorporate additional diagnostic examinations to ascertain the presence or absence of bone metastases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e6. The role of Artificial Intelligence (AI) in the diagnosis of PCa: With the continuous advancement of AI within the field of modern medicine, the application of AI in the diagnosis, differentiation, and evaluation of PCa demonstrates both feasibility and significant clinical applicability\u003csup\u003e[15,16]\u003c/sup\u003e. However, when compared with traditional inspection approaches, the accuracy and interpretability of this method still necessitate extensive clinical trials for validation.\u003c/p\u003e\n\u003cp\u003eIt is noteworthy that the use of immunosuppressants after kidney transplantation has been proven to increase the risk of developing malignancies and infections. Among these, the occurrence of malignancies post-transplantation ranks as the third most common cause of death in transplant recipients. Notably, Kaposi's sarcoma, lymphoma, and non-melanoma skin cancer exhibit the highest incidence rates among these malignancies\u003csup\u003e[17]\u003c/sup\u003e. It is estimated that the overall risk of developing malignancies in kidney transplant recipients is approximately three times higher than that in the general population. The risk of malignancy after a decade of long-term immunosuppressive therapy is about 20% , and it increases to approximately 30% after 20 years. The risk of malignancy in this patient population varies by cancer type, ranging from 1.3 times higher (for breast cancer) to 250 times higher (for cutaneous squamous cell carcinoma) compared to the general population\u003csup\u003e[18]\u003c/sup\u003e.\u0026nbsp;However, some scholars have also proposed that the incidence of cancers that are relatively common in the general population (such as breast cancer, prostate cancer, and lung cancer) is comparable among kidney transplant recipients\u003csup\u003e[19]\u003c/sup\u003e.\u0026nbsp;Additionally, PSA is not exclusive to cancer; elevated PSA levels can also be caused by benign prostatic hyperplasia, and prostatitis. However, in this case, despite appropriate antibiotic treatment leading to an improvement in inflammatory markers, the PSA levels gradually increased, suggesting a high likelihood of tumor development.\u003c/p\u003e\n\u003cp\u003eSince the advent of antibiotics, the incidence of PA has been continuously declining, accounting for approximately 0.5% of all urinary system diseases, with a higher prevalence among patients with diabetes and those with compromised immune function\u003csup\u003e[20]\u003c/sup\u003e. Symptoms of PA overlap with those of other urinary system diseases. Its characteristic sign is tenderness upon palpation in the prostatic region during DRE. However, studies have indicated that only 52.2% of PA patients exhibit positive DRE findings\u003csup\u003e[21]\u003c/sup\u003e. It is challenging to differentiate between PA and PCa based solely on medical history and physical examination. Mp-MRI plays a pivotal role in the diagnostic process of PA. The MRI manifestations of PA are largely dependent on the structures within the abscess wall and the abscess cavity. DCE-MRI imaging can reveal significant enhancement of the abscess wall with no enhancement in the abscess cavity, whereas entire lesion of PCa exhibits pronounced and homogeneous enhancement. Given the distinct pathological foundations and varying degrees of water molecule diffusion between PCa and PA, these differences manifest as signal variations on DWI and ADC maps. In PCa, restricted diffusion of tumor molecules is\u0026nbsp;attributed to compression of the extracellular space, whereas in PA, the restricted diffusion of water molecules within the abscess cavity arises from an expansion of the extracellular space. Consequently, the degree of diffusion restriction is lower in PCa than in PA, and the ADC values of PCa are higher than those of PA\u003csup\u003e[22]\u003c/sup\u003e. Therefore, DWI sequence exhibits high sensitivity in detecting minute abscesses. In this case, the enhanced appearance of the region with restricted diffusion on DWI is clearly inconsistent with the typical imaging manifestations of PA. Furthermore, PCa tissue generally presents as uniformly hypointense on T2WI, while PA often shows hyperintensity on T2WI due to intracavitary liquefactive necrosis. These imaging features can also serve as distinguishing points between the two conditions.\u0026nbsp;\u003c/p\u003e"},{"header":"4 Conclusion","content":"\u003cp\u003eThe misdiagnosis of PCa is influenced by multiple factors: insufficient specificity of prostate cancer-related biomarker tests, atypical imaging signs, and insufficient understanding among clinicians about PCa. Meanwhile, comorbidities in patients themselves also interfere with the diagnostic accuracy to a certain extent. To address the above issues, it is necessary to construct a multimodal diagnostic system, integrate multiple examination techniques, and strengthen the training of clinicians on complex PCa, so as to improve the diagnostic accuracy.\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003ePCa\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProstate cancer\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003ePA\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProstatic abscess\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003eMp-MRI\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMultiparametric magnetic resonance imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003eDCE-MRI\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDynamic contrast-enhanced magnetic resonance imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003ePSA\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eProstate specific antigen\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003eThis study was approved by the Ethics Committee of Ningbo Yinzhou NO.2 Hospital. In addition, informed consent was taken from the patient.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e Written informed consent was obtained from the patient for publication of this case report and any accompanying images.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no external funding.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by Y W, and analysis were performed by J W. The first draft of the manuscript was written by Y W and all authors commented on previous versions of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e This work was supported by the radiology departments of Ningbo Yinzhou NO.2 Hospital, China, which provided comprehensive help. In addition, we are very grateful to my colleagues and friends for their contributions to this paper.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMo Q, Wang F, Liang H, Li Y, Qin M, et al. Tracking and analysis of benign prostatic hyperplasia and prostate cancer burden globally: 1990-2021 epidemiological trends. \u003cem\u003eTransl Androl Urol\u003c/em\u003e. (2025) 14: 764-778. DOI: 10.21037/tau-2025-12. \u003c/li\u003e\n\u003cli\u003eAdam S, Jessica B, F. M A, et al. 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Establishment and prospective validation of an SUVmax cutoff value to discriminate clinically significant prostate cancer from benign prostate diseases in patients with suspected prostate cancer by \u003csup\u003e68\u003c/sup\u003eGa-PSMA PET/CT: a real-world study. \u003cem\u003eTheranostics\u003c/em\u003e. (2021) 11:8396-8411. DOI：10.7150/THNO.58140.\u003c/li\u003e\n\u003cli\u003eRoest C, Kwee TC, de Jong IJ, Schoots IG, van Leeuwen P, Heijmink SWTPJ, et al. Development and Validation of a Deep Learning Model Based on MRI and Clinical Characteristics to Predict Risk of Prostate Cancer Progression. \u003cem\u003eRadiol Imaging Cancer\u003c/em\u003e. (2025) 7: e240078. DOI: 10.1148/rycan.240078. .\u003c/li\u003e\n\u003cli\u003eChen T, Hu W, Zhang Y, Wei C, Zhao W, Shen X, Zhang C, Shen J. A Multimodal Deep Learning Nomogram for the Identification of Clinically Significant Prostate Cancer in Patients with Gray-Zone PSA Levels: Comparison with Clinical and Radiomics Models. \u003cem\u003eAcad Radiol\u003c/em\u003e. (2025) 32: 864-876. DOI: 10.1016/j.acra.2024.10.009.\u003c/li\u003e\n\u003cli\u003eNabi Z, Zahid T, Nabi R. Post Renal Transplant Malignancies; A Basic Concept.\u003cem\u003e J Ayub Med Coll Abbottabad\u003c/em\u003e. (2023) 35: 664-668. DOI: 10.55519/JAMC-04-12230. \u003c/li\u003e\n\u003cli\u003eCiesielski W, Frąk W, Gmitrzuk J, Kuczyński P, Klimczak T, et al. The assesement of the long-term effects of kidney transplantation, including the incidence of malignant tumors, in recipients operated on between 2006 and 2015 - a cohort study and literature review. \u003cem\u003ePol Przegl Chir\u003c/em\u003e. (2025) 97: 1-9. DOI: 10.5604/01.3001.0054.9677.\u003c/li\u003e\n\u003cli\u003eMedeiros E, Merhi B. Malignancy After Renal Transplantation: A Review. \u003cem\u003eR I Med J (2013)\u003c/em\u003e. (2021) 104: 25-30. PMID: 33517595. \u003c/li\u003e\n\u003cli\u003eWettstein J, Lynch W, Graham M B. Prostatic Abscess Presenting as Penile Discharge: A Case Report. WMJ. (2025) 124: 69-70. PMID: 40262012\u003c/li\u003e\n\u003cli\u003eSakakiyama M, Hayashi K, Tada M, Hayashi M, Nakaya Y, et al. Prostatic Abscess by Morganella morganii. \u003cem\u003eCureus\u003c/em\u003e. (2025) 17: e86265. DOI: 10.7759/cureus.86265. \u003c/li\u003e\n\u003cli\u003eRen J , Huang X , Wang H , et al. Prostatic abscess and seminal vesicle abscess: MRI findings and quantitative analysis of apparent diffusion coefficient values. \u003cem\u003eRadiol Infect Dis\u003c/em\u003e. (2015) 2: 27-32. DOI: 10.1016/j.jrid.2015.04.003. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prostate cancer, Prostatic abscess, Misdiagnosis, Diagnosis, Case report","lastPublishedDoi":"10.21203/rs.3.rs-7377880/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7377880/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eAs one of the most common malignant tumors in men, prostate cancer (PCa) has garnered substantial research investment from the medical community. However, due to multiple challenges in diagnostic techniques and clinical practice, cases of missed diagnosis and misdiagnosis still persist.\u003c/p\u003e\n\u003cp\u003eCase presentation\u003c/p\u003e\n\u003cp\u003eThis article presents a case of a 36-year-old male patient who had undergone kidney transplantation. Initially, he was misdiagnosed with a prostatic abscess (PA) due to symptoms such as perineal heaviness and mild tenesmus. However, the diagnosis was later confirmed as PCa through surgical intervention.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eThis case highlights the similarities in symptoms and imaging manifestations between PCa and PA, as well as the complexity involved in diagnosing PCa. Furthermore, it underscores the significance for clinicians to rationally utilize clinical examination methods, remain vigilant about the heightened risk of malignancies following kidney transplantation, and enhance their ability to differentiate and diagnose prostate cancer. These efforts contribute to accumulating experience for the early diagnosis of PCa.\u003c/p\u003e","manuscriptTitle":"Prostate cancer misdiagnosed as prostatic abscess: case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 10:56:56","doi":"10.21203/rs.3.rs-7377880/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-10T16:54:04+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"212866436275474372719854314675011888535","date":"2025-09-08T04:56:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-08T02:08:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T16:55:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T15:28:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"300772703147082351961284400259073446735","date":"2025-09-07T15:15:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336562909600226921757861808940190977350","date":"2025-09-06T06:07:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172406477074197645081044520776213166364","date":"2025-09-04T05:07:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266007194444092872327767147074047885895","date":"2025-09-04T02:19:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T23:45:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T23:26:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-25T18:48:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-25T12:00:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-08-25T11:57:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cbf1c43-b633-4f0c-bce4-bd4d3d590672","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:04:05+00:00","versionOfRecord":{"articleIdentity":"rs-7377880","link":"https://doi.org/10.1186/s12894-025-01982-6","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2025-11-18 15:58:44","publishedOnDateReadable":"November 18th, 2025"},"versionCreatedAt":"2025-09-11 10:56:56","video":"","vorDoi":"10.1186/s12894-025-01982-6","vorDoiUrl":"https://doi.org/10.1186/s12894-025-01982-6","workflowStages":[]},"version":"v1","identity":"rs-7377880","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7377880","identity":"rs-7377880","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}