EP890 - Blessing in Disguise: Incidental Finding of Prostate Cancer in a 37-year-old From Prostatic Urethral Injury During Proctocolectomy for Crohn's Disease

Purpose/Background: Published data suggest an increased risk of prostate cancer in patients with inflammatory bowel disease. The majority of publications focus on the relationship between ulcerative colitis and prostate cancer, with a paucity of published data on prostate cancer associated with Crohns disease. Herein, we report a case depicting a young man with long-standing Crohn’s disease who experienced an iatrogenic injury to the prostatic urethra during proctocolectomy, which led to an incidental discovery of prostate cancer.

Methods/Interventions: A 37-year-old male with a long-standing history of colonic, rectal, and severe fistulizing perianal Crohn’s disease refractory to optimal medical therapy with steroids, multiple biologics, and fecal diversion underwent robotic-assisted laparoscopic total proctocolectomy. Intraoperatively, significant perineal fibrosis and dense adhesive disease were identified. The degree of disease ultimately required extensive perineal dissection and resulted in an iatrogenic prostatic urethral injury. Urology was consulted intraoperatively, and the bladder injury was promptly repaired.

Results/Outcomes: Pathological examination incidentally revealed prostatic adenocarcinoma at the area of injury, specifically the anal fistula excision specimen. Assigned Gleason Grade was 3+3 (score 6). Total prostate specific antigen (PSA) was 1.8. Uropathology identified positive immunoreactivity to NKX3.1, a tumor suppressor gene in the prostate. The patient is currently undergoing surveillance and management of prostate adenocarcinoma under the care of the urology team.

Conclusion/Discussion: This case exposes the potential association between prostate cancer and inflammatory bowel disease, specifically Crohn’s disease. Furthermore, this case identifies a younger patient with disease, and underscores the need for further research into early screening strategies in this population.