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Despite a large invasive pelvic mass, his PSA remained undetectable, and PSMA PET\/CT was negative, initially suggesting an alternative diagnosis such as rectal carcinoma. Colonoscopic biopsy was non-diagnostic, but prostate biopsy confirmed recurrent Gleason 9 adenocarcinoma. The patient deteriorated rapidly and died within 3 months. This case underscores the need for histological confirmation when PSA, PSMA PET\/CT, and the clinical picture are discordant, even in previously well-controlled disease.<\/jats:p>","DOI":"10.1136\/bcr-2025-270303","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:55:26Z","timestamp":1779195326000},"page":"e270303","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Rectal-cancer mimic of recurrent high-grade prostate adenocarcinoma"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9772-2143","authenticated-orcid":false,"given":"Anita","family":"Medepalli","sequence":"first","affiliation":[{"name":"Mercer University School of Medicine, Macon, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoonhee","family":"Kim","sequence":"additional","affiliation":[{"name":"Family Medicine, Mercer University School of Medicine, Macon, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"2026051905550983000_19.5.e270303.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026051905550983000_19.5.e270303.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21820"},{"key":"2026051905550983000_19.5.e270303.3","first-page":"1","article-title":"EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on prostate cancer\u20142023 update","volume":"84","author":"Mottet","year":"2023","journal-title":"Eur Urol"},{"key":"2026051905550983000_19.5.e270303.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.03.048"},{"key":"2026051905550983000_19.5.e270303.5","first-page":"19","article-title":"Prostate cancer, version 2.2025, NCCN Clinical Practice Guidelines in Oncology","volume":"23","author":"Mohler","year":"2025","journal-title":"J Natl Compr Canc Netw"},{"key":"2026051905550983000_19.5.e270303.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61815-2"},{"key":"2026051905550983000_19.5.e270303.7","unstructured":"National Comprehensive Cancer Network . 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