The Kilogland: Giant prostatic hyperplasia with incidental prostate adenocarcinoma

A 74-year-old man with PSA of 21.1 ng/mL, eGFR of 13 mL/min/1.73 m² (stage 4 renal disease), and an 889 mL prostate (MRI; transrectal ultrasound estimated 1000 mL) underwent robotic simple prostatectomy for severe lower urinary tract symptoms, including nocturia and recurrent urinary retention. Adenoma dissection, bladder re-anastomosis, and morcellation resulted in 500 mL blood loss and one transfusion. Pathology revealed stromal/glandular hyperplasia and incidental Gleason 8 (3 + 5) adenocarcinoma (<2 % of tissue, no invasion). At six months, PSA was 0.25 ng/mL, with good continence. This case highlights successful robotic management of massive BPH with incidental malignancy.