Concurrent Jackstone Calculus and Prostate Cancer: Should They Be Treated Concurrently or Sequentially?
Abstract
Jackstone calculus is a rare urinary stone morphology with a distinctive spiculated appearance, most often reported in the bladder and usually associated with urinary stasis or outlet obstruction. We report a 70-year-old man with 1 year of progressive dysuria and intermittent interruption of urinary stream despite tamsulosin and finasteride. Urinalysis showed pyuria, hematuria, and bacteriuria. Ultrasonography and pelvic computed tomography identified an irregular star-shaped bladder stone and marked prostatic enlargement, with an estimated prostate volume of approximately 125 mL on ultrasonography. Serum total prostate-specific antigen was 16.2 ng/mL, with a free-to-total ratio of 0.138. Systematic transrectal biopsy showed adenocarcinoma in 2 of 12 cores, Gleason score 3 + 3 = 6 (Grade Group 1). After multidisciplinary discussion, the patient underwent laparoscopic radical prostatectomy with concomitant intact stone removal. The 3.1-cm stone showed classic jackstone morphology. Final pathology showed Gleason 3 + 4 = 7 adenocarcinoma (Grade Group 2), upgraded from biopsy, with negative surgical margins. Telephone follow-up at 1, 3, and 12 months showed sustained improvement of lower urinary tract symptoms without recurrent urinary tract infection-related symptoms. Postoperative imaging and prostate-specific antigen data were unavailable. This case is relevant to men's health because a visually distinctive bladder stone may coexist with clinically relevant prostatic disease.…
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