Prostate lymphoma uncovered during urological encounters: Diagnostic challenges and clinical outcomes in a case series with systematic review of the literature.

INTRODUCTION: Prostatic lymphoma is a rare malignancy that can clinically resemble benign prostatic hyperplasia (BPH) or adenocarcinoma, often delaying diagnosis. Primary prostatic lymphoma (PPL) comprises <0.1% of prostate tumors and non-Hodgkin lymphomas, whereas secondary involvement occurs more commonly in systemic disease. METHODS: A retrospective review was conducted at the University of Miami Health System (2015-2024). All prostate specimens demonstrating lymphoma or related hematologic malignancies were identified. Clinical data, including demographics, presenting symptoms, prostate-specific antigen (PSA), imaging, uroflowmetry, histopathology, urological and oncologic treatment, and outcomes, were collected. A PubMed and Embase literature review was performed to identify reported PPL cases. RESULTS: Seven patients (age range 47-89) were diagnosed with prostatic lymphoma. Presenting features included lower urinary tract symptoms, hematuria, urinary retention, pelvic pain, and systemic B symptoms. Histologic findings included diffuse large B-cell lymphoma (n = 3), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 2), low-grade B-cell lymphoma (n = 1), mucosa-associated lymphoid tissue (MALT) lymphoma (n = 1), and mantle cell lymphoma (n = 1). One additional case of myeloid sarcoma was identified and reported separately. Several diagnoses followed tissue sampling during radical prostatectomy, holmium laser enucleation of the prostate (HoLEP), or transurethral resection of prostate (TURP) for presumed BPH. Management varied, including rituximab-based chemoimmunotherapy, targeted agents, radiotherapy, and conservative strategies. Outcomes ranged from remission to systemic progression. The literature review identified 65 studies involving 160 patients with PPL. CONCLUSION: Prostatic lymphoma is a heterogeneous entity with presentations that overlap with those of common urologic conditions. Histopathologic confirmation is essential in patients with atypical features or poor response to BPH therapies. Early recognition and multidisciplinary coordination are vital.