54-year-old man, smoker of 30 cigarettes a day. He first consulted the urology department in May 2000 for lower urinary tract infection and left renal colic.
Rectal examination revealed a fixed, stony, irregular prostate in both lobes. Ultrasonography shows no alterations of interest, except for an enlarged prostate for his age (prostate weighing approximately 65 grams). The PSA is 223.
Prostate biopsy revealed 6 markedly infiltrated cylinders of adenocarcinoma Gleason VII. A staging bone scan was performed, which showed no evidence of bone pathology, and complete androgen blockade with antiandrogens and LH-RH analogues was initiated (August 2000).
During follow-up, PSA levels gradually increased (January 2001: 0.5, August 2001: 0.7, February 2002: 6.4, April 2002: 14), without the patient noticing any worsening of his general condition.
In February and April 2002, he visited the emergency department for two episodes of haematuria and urinary retention, requiring bladder catheterisation for a month. His obstructive symptoms progressively worsened over two months, reaching the point of almost dribbling urine in June 2002. The urine flow study in May 2002 showed a peak flow of 2 ml/sec, with a residual of 80 ml. Due to this clearly obstructive worsening of his disease, transurethral resection of the prostate was proposed.
In July 2002, when the resector was introduced to perform the resection of the prostate, a penile urethra full of 0.5-1 cm polypoid mamelon formations was observed, which made entry into the bladder difficult, as they reduced the urethral calibre and bled when rubbed. The rest of the bulbar and prostatic urethra is normal, the latter being somewhat unstructured. T.U.R. was not performed because it was difficult to see.

In July 2002, after finding a PSA of 22, antiandrogens were withdrawn, keeping the analogues and including the patient in a trial with Atrasentan (M00- 244).
The persistence of severe obstructive symptoms justified a resection of the urethral mamelons and the prostate, and both samples were sent separately to the anatomical pathology department to obtain histological affiliation of the urethral mamelons. Bladder catheterisation was maintained for 3 weeks. The histological diagnosis of the urethral tissue was: masses formed exclusively by a Gleason X adenocarcinoma. Regarding the prostate tissue itself, the diagnosis was the same.
At present, the patient is in excellent general condition, attending the relevant consultations according to the trial protocol, with no symptoms derived from his illness.