KLK3 and Familial prostate cancer: Isolated anterior urethral metastasis from prostate cancer is extremely rare and may present many years after primary treatment. PSA levels can be discordant with disease activity, and recurrence may occur despite an undetectable nadir, making clinical vigilance essential. New urethral symptoms in men with a history of prostate cancer should prompt endoscopic and histological evaluation, even when PSA is reassuring.