LAUSR

A 74-year-old man with a history of prostate cancer, nephrolithiasis, recurrent urinary retention presented to clinic with 2 years of pelvic discomfort and dysuria and a 1 week history of new onset haematuria and urethralgia. Just prior to this presentation, a urologist in an outside healthcare system performed a cystoscopy that demonstrated significant burden of calculi adherent to a prior TURP defect. The patient denied a history of infections, but had underwent protonbeam radiotherapy (RT; 8000 cGy) for Gleason 3 + 4 prostate cancer 6 years prior to presentation. This was complicated by the subsequent development of a bladder neck contracture, precipitating recurrent episodes of urinary retention that was treated with a transurethral incision of bladder neck and resection of the prostate 3 years prior to presentation. Since then, he has had no evidence of biochemical recurrence with undetectable PSA. CT imaging revealed ~4 cm of dense calcification within the prostatic fossa, with an average 650 Hounsfield units (Fig. 1). Laboratory values were unremarkable including undetectable PSA, creatinine of 83.98 lmol/L, calcium of 0.6 mmol/L, and haemoglobin of 154 g/L. Urine analysis at clinic encounter demonstrated rare calcium oxalate crystals but was negative for infection.