Basal cell carcinoma of the prostate diagnosed incidentally with holmium laser enucleation of the prostate: How can we detect prior to benign prostatic hyperplasia surgery?

INTRODUCTION: Basal cell carcinoma of the prostate is a rare prostate malignancy. Its diagnosis and treatment have not been well established yet. CASE PRESENTATION: An 80‐year‐old man was referred to our hospital for undergoing holmium laser enucleation of the prostate with persistent lower urinary tract symptoms. Ultrasonography showed enlarged prostate (41.3 cc) with mid‐lobe hypertrophy. His prostate‐specific antigen and testosterone levels were 0.437 ng/mL and 873 ng/dL, respectively. Histological examination of the enucleated tissue confirmed basal cell carcinoma. The cells were positive for bcl‐2, 34βE12, p63, and cytokeratin 5/6. Ki‐67 labeling index was 5%. Subsequent staging computed tomography scan and bone scintigram showed neither lymph node nor distant metastasis. Currently, the patient is under close follow‐up with imaging, endoscopy, and urodynamic study. CONCLUSION: It is difficult for physicians to detect prostate basal cell carcinoma before benign prostatic hyperplasia surgery. In case of organ‐confined disease, age and Ki‐67 labeling index could be suggestive of subsequent treatment decision‐making.