Case of Basal Cell Prostate Cancer and Recurrence With Prostatic Adenocarcinoma in a United States Military Veteran Exposed to Agent Orange

ABSTRACT Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death in men. Acinar adenocarcinoma accounts for 90% of primary prostatic cancers. Carcinoma of the basal cells of the prostate is extremely rare, making up less than 1% of prostate cancer diagnoses. As opposed to adenocarcinoma, basal cell‐type carcinoma of the prostate (BCCP) does not usually secrete PSA and most commonly presents with symptoms of typical BPH. Due to its nonspecific symptoms and absence of PSA secretion, it is often diagnosed at the locally advanced stage. In part due to its rarity, there are no standardized treatment protocols. Agent Orange (AO) is a pesticide utilized by the US Military during the Vietnam War, which was contaminated with polychlorinated dibenzo‐dioxins (PCDDs). These compounds have been linked to the development of various malignancies, including prostate cancer, although a direct causal relationship remains unproven. We present the case of a US Vietnam Veteran with Agent Orange exposure who was diagnosed with multiple distinct types of prostate cancer, including BCCP. He was initially found to have BCCP on pathological evaluation of prostate tissue from a prostatic resection for BPH. He was treated with definitive radiotherapy. He subsequently developed a recurrence of prostate cancer, but on this occasion, he was found to have localized prostatic adenocarcinoma and was treated with salvage High Intensity‐Focused Ultrasound (S‐HIFU). He remained without recurrence to the time of the writing of this report, 60 months after undergoing S‐HIFU. Upon review of the literature, there is a lack of data regarding the environmental exposures of patients who develop BCCP, as well as a lack of documentation of rare subtypes of prostate cancers that have been identified in AO‐exposed Veterans. Further studies on this subject would be beneficial, as there are millions of US veterans alive who had exposure to PCDDs during the Vietnam War and the more recent Global War on Terror.