Prostate malignancies are rare in young adults, particularly in individuals under 30, and are typically aggressive when diagnosed. This case presents a 24-year-old Aboriginal male with no prior medical history who was found to have a high-grade, undifferentiated prostate malignancy following a motor-vehicle accident. Although haematuria was triggered post-accident, imaging and cystoscopy revealed a significant undifferentiated tumour, prompting urgent surgical intervention. We aim to explore the diagnostic challenges and treatment approach in this atypical case.

The patient, a 24-year-old male, presented to the emergency department with haematuria following a motor-vehicle accident where he was a passenger in a car that collided with a kangaroo. Initial clinical evaluation revealed no injuries, but computed tomography (CT) imaging suggested prostatomegaly with intravesical protrusion. Flexible cystoscopy under local anaesthetic revealed abnormal friable tissue in the prostatic fossa, which led to a transurethral resection of the prostate and bladder tumour. Histopathology identified a high-grade undifferentiated malignancy. Genetic and immunohistochemical testing failed to determine a definitive diagnosis, excluding sarcoma and poorly differentiated carcinoma.

Postoperative MRI revealed a heterogeneously enhancing tumour involving the prostate base and adjacent bladder, with cystic areas indicating necrosis. Staging via positron emission tomography (PET) and CT scans identified right para-rectal and bilateral inguinal lymphadenopathy, though no distant metastases were found. The patient underwent neoadjuvant chemotherapy with doxorubicin and ifosfamide, achieving a radiological response but discontinuing due to side effects. Radical cystoprostatectomy with ileal conduit formation was performed, with histopathology confirming tumour involvement from base to apex, including left seminal vesicle and bladder. Postoperative PET scans showed no metastases, and the patient underwent 21 fractions of adjuvant radiotherapy.

This case highlights the rare occurrence of high-grade undifferentiated prostate malignancy in a young adult, an aggressive tumour type with poor prognosis. The patient’s case is unique in that the malignancy was incidentally discovered following a traumatic event, expediting diagnostic workup and treatment. Despite aggressive treatment, the overall outcomes for young adults with prostate malignancy remain challenging. This case underscores the importance of thorough diagnostic evaluation in young patients presenting with haematuria, even in the absence of typical risk factors. It also represents the first such case reported in an Indigenous Australian male, contributing valuable insights to the literature on rare prostate cancers in younger populations.