Prostate Cancer Associated with Hemorrhagic Cyst: Findings on Transrectal Doppler Sonography

Cysts in the region of the prostate are common and may present as either intraprostatic or periprostatic. However, a hemorrhagic cyst in this area is unusual. A 62-year-old man was transferred to our hospital for elevated serum prostate-specific antigen (502 ng/mL). A digital rectal examination revealed a non-tendered fluctuation over the prostate, masquerading as an abscess-like lesion. The urine was sterile. Transrectal sonography revealed a cystic lesion over the apical portion of the prostate. On color and power Doppler appearance, mildly increased vascularity but asymmetric distribution was found. With the patient's consent, about 20 mL of sterile, non-coagulant, dark, bloody fluid was aspirated under sonographic guidance. After aspiration, the prostate outline returned to a near normal but existed as an echo-heterogeneous entity. Bilateral sextant biopsy was simply performed thereafter and pathology showed adenocarcinoma from each core (Gleason score, 4 + 5/10). Hormonal therapy was administered because of multiple bony metastases. However a cyst in this area is unusual. We herein report a newly diagnosed prostrate cancer associated with a hemorrhagic cyst which was masquerading as a abscess-like lesion. The Doppler transrectal sonographic appearance of this particular case of prostate cancer is also described.