From Adenocarcinoma Suspicion to Diffuse Large B‐Cell Lymphoma: The Impact of Healthcare Access Barriers—A Case Report

Primary prostatic lymphoma is an uncommon malignancy that may clinically and radiologically mimic adenocarcinoma, often delaying diagnosis. We report a case of diffuse large B‐cell lymphoma (DLBCL) of the prostate to highlight distinguishing features during the approach. A 78‐year‐old man presented with progressive lower urinary tract obstruction, a stony‐hard prostate with highly suspicious lesion on MRI, and a modest prostate‐specific antigen (PSA) rise (1.0 to 2.1 ng/mL). He developed obstructive uropathy with renal failure requiring bilateral nephrostomies. Histopathology from transurethral resection confirmed DLBCL of germinal center B‐cell. PET‐CT showed intense uptake (SUVmax 23.7) in the prostate, left seminal vesicle, and urethra. Prostatic DLBCL should be suspected when marked local disease contrasts with low PSA levels. Accurate histopathologic diagnosis is essential, as management requires systemic chemoimmunotherapy rather than prostate‐directed treatment.