# Challenges in the diagnosis of primary squamous cell carcinoma of the prostate: a case report and literature review

## TL;DR

This case report highlights the diagnostic challenges of a rare prostate cancer type, squamous cell carcinoma, which can be misdiagnosed as benign prostatic hyperplasia.

## Contribution

The paper presents a case of primary squamous cell carcinoma of the prostate misdiagnosed preoperatively and emphasizes the need for better diagnostic tools.

## Key findings

- Primary squamous cell carcinoma of the prostate is rare and often misdiagnosed due to non-specific symptoms and imaging findings.
- Pathological confirmation is essential for diagnosing SCCP, especially in elderly patients with benign prostatic hyperplasia-like symptoms.
- Non-invasive diagnostic methods like fluorescence imaging may improve prostate cancer detection.

## Abstract

Prostate squamous cell carcinoma (SCCP)is a rare malignancy that accounts for 1% of prostate cancer cases. In resource-limited settings, it is often at an advanced stage due to the limitations of PSA/imaging-based methods, and pathological confirmation is needed for a definitive diagnosis, particularly in elderly patients with comorbidities.

A 71-year-old male with benign prostatic hyperplasia presented with urinary obstruction confirmed by urine flowmetry. Digital rectal examination of the prostate revealed severe enlargement, a firm consistency and an irregular surface; B-mode ultrasonography revealed calcifications without focal lesions. Laboratory tests revealed hematuria, elevated RBC counts, reduced WBC counts, normal serum PSA, and negative microbiological cultures. Cystoscopy revealed bladder wall thickening with multiple diverticula, suggesting chronic obstructive sequelae. Through physical, laboratory, and imaging examinations, we diagnosed the patient with benign prostatic hyperplasia before surgery. The postoperative pathological diagnosis was SCCP. The patient was discharged 7 days post-surgery and treated for prostate cancer (PCa) at a higher-level hospital.

in vivo fluorescence imaging and laboratory examination of PCa targets are needed to further promote noninvasive PCa diagnosis.