Isolated pulmonary metastatic disease from prostate cancer as an initial symptom in a patient following transurethral resection of the prostate for benign disease with normal histopathology

Benign prostatic hyperplasia (BPH) remains a predominant cause of acute urinary retention (AUR) in elderly males. Transurethral resection of the prostate (TURP) is the gold-standard treatment for BPH, often uncovering incidental prostate cancer (IPC). Here, we present a unique case of an 80-year-old patient with refractory AUR due to BPH who underwent TURP. Despite benign histopathology, the patient developed isolated pulmonary metastases as the initial symptom of prostate cancer (PCa) eight months postoperatively. Diagnostic evaluation revealed advanced PCa with a Gleason Score of 8 and no other metastases. The rapid progression suggests potential vascular dissemination during TURP, although evidence remains inconclusive. This case highlights the importance of diligent follow-up post-TURP to exclude occult PCa, particularly in high-risk patients. The findings also raise questions about current histopathological evaluation protocols and the need for standardized follow-up practices to improve early detection and management of advanced PCa.