Carcinoma in situ (CIS) of the bladder, first described by Melicow MM. in 1952, is recognized as a malignant bladder condition carrying a significant risk for disease progression and increased mortality due to bladder cancer [4]. It can be identified at various times, including (1) Primary CIS, when there’s no previous bladder cancer history; (2) Concomitant CIS, when it’s found at the same time as non-muscle-invasive (NMIBC) or muscle-invasive (MIBC) bladder cancers; and (3) Secondary CIS, when it’s detected in follow-up in patients who have had bladder cancer before [1]. Having a first-degree relative who has been diagnosed with bladder cancer significantly increases the risk of developing the disease [5]. The patient’s father’s death from bladder cancer further emphasizes the potential hereditary risk factors associated with the condition. While it’s known that smoking can elevate the risk of developing bladder cancer by up to fivefold [1, 3], in this instance, the patient has no history of smoking. Due to the lack of a specific screening test for bladder cancer, the diagnostic process frequently depends upon the recognition of some clinical manifestation in primary healthcare settings [6]. Shephard EA and colleagues’ study among those patients revealed seven distinct characteristics that were independently predictive of bladder cancer, which were gross hematuria, dysuria, urinary tract infection, leukocytosis, abdominal pain, elevated inflammatory markers, and elevated creatinine levels [7]. The Expert Panel of the American Urological Association has described asymptomatic microscopic hematuria as identifying “three or more red blood cells per high-power field” when examining urinary sediment under a microscope, from at least two of three urine samples collected correctly [8]. In this case, the initial urinalysis revealed 60–80 RBCs per field with positive hemoglobin, in conjunction with gross hematuria. A follow-up urinalysis four weeks later still showed 8–10 RBCs per field. And thus, further testing was pursued to determine the cause of the patient’s persistent microscopic hematuria. Roughly 75% of bladder cancer patients exhibit intermittent hematuria that is painless. Studies suggest that around 20% of individuals assessed for gross hematuria will end up with a diagnosis of bladder cancer. In cases where patients have non-visible, microscopic blood traces in the urine, there’s about a 10% chance they will be found to have bladder cancer [3]. The clinical assessment of the spread of UC can be challenging, but combining the histopathological reports with imaging methods such as Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) can aid in determining the size and extent of the primary tumor and identifying any metastases to lymph nodes or distant organs [9]. The occurrence of primary initial CIS of the prostate is exceptionally uncommon. Around 90% of prostatic CIS cases are detected alongside either papillary or invasive urothelial carcinoma (UC), commonly situated in the bladder, as the presence of bladder CIS elevates the risk of concurrent prostatic CIS [2]. Accurately assessing the full extent of CIS within the prostate is crucial. For optimal results, a biopsy should be taken from the prostatic urethra using a resectoscope with a loop electrode, focusing on regions at the 5 and 7 o’clock marks stretching from the bladder neck to the verumontanum, which includes the areas of the ejaculatory ducts [2]. Such a procedure is key to detecting whether the CIS has invaded the prostatic ducts (pdCIS) or infiltrated the prostatic stroma (psCIS), while it’s also noted that in 20% of cases, CIS remains localized to just the prostatic urethra (puCIS) [2]. Stromal invasion is associated with poorer survival compared to non-invasive disease, with a 15-year survival rate of 82% for patients without invasion, whereas it drops to 48% for those with stromal invasion [10]. In this instance, the prostatic urethra was clear of any malignancy; however, a solitary metastasis was identified within the prostatic ducts. The mechanisms behind this selective metastasis may be linked to the anatomy of the prostatic ducts and their fluid dynamics [11], or possibly due to the expression of specific adhesion molecules or growth factors that facilitate the migration of cancer cells to this location [12]. Primary UC typically presents with positive GATA-3 marker results [13], which aligns with the findings in this particular case. This lesion progressed to invade the peripheral zone of the prostate, at which point it was reclassified from CIS, and thus required the implementation of an aggressive approach to treatment [2]. Research comprising numerous trials and meta-analyses regarding radical cystectomy for treating locally advanced bladder cancer strongly supports its efficacy, with a notable increase in the survival rates without recurrence among these patients. The critical factor in achieving optimal outcomes following radical cystectomy is the proficiency with which the procedure is performed [14]. Early cystoprostatectomy in patients with minimal stromal involvement and organ-confined bladder cancer may lead to improved survival rates. Studies by Herr and Donat, as well as Esrig et al., have shown better survival outcomes in patients with prostatic stromal invasion through the intraurethral route (ranging from 64.6 to 75%) compared to non-organ-confined “extravesical” bladder tumors (ranging from 13.6 to 9%) [15]. Radical cystectomy alone is often insufficient to cure locally advanced bladder cancer (T3-T4a N0M0), making adjuvant chemotherapy highly recommended to reduce the risk of recurrence [14]. Both methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) and gemcitabine and cisplatin (GC) chemotherapy combinations are utilized, but GC has demonstrated superior safety and improved 5-year survival statistics, thus it is now favored over the MVAC regimen [16].