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Prostate biopsies were taken and revealed 'undiCerenCase report tiated' carcinoma on initial histology. After counselling, he underwent staging investigations which revealed no A previously healthy 53-year-old man presented with a short history of lower urinary tract symptoms, dysuria, metastasis. However, a pre-operative histological assessment of deeper sections and PSA immunostaining intermittent frank haematuria and rigors. He was treated empirically with ciprofloxacin by his GP. On referral, his revealed no tumour but florid diCuse granulomatous prostatitis ( Fig. 1). At follow-up, he was asymptomatic symptoms were resolving; he had a firm, smooth, moderately enlarged non-tender prostate. Investigations, but had persistently elevated PSA levels of about 10 ng/mL. TRUS carried out at 6 and 12 months was including urine culture, cystoscopy and IVP, were normal apart from his PSA level, which was 12.5 ng/mL.reported as showing BPE. Biopsies at this stage revealed only hyperplasia; 15 months later, further biopsies revealed a focus of moderately diCerentiated adenocarcinoma. The patient opted for radical prostatectomy after this prolonged traumatic period. The operative specimen revealed small confined foci of adenocarcinoma (Gleason grade 2+3=5) with a total volume of <4 mL and surrounding fibrous hyperplasia (Fig. 2). He remains well with no evidence of recurrence after surgery. CommentThere can be clinical, histological and psychological pitfalls with diagnosing diCuse granulomatous prostatitis in patients with elevated PSA levels. The condition may mimic prostatic malignancy, both clinically and histologically [1]. PSA levels may rise but this increase is elevation must be followed up after appropriate counselling and only after careful assessment of the histology with appropriate immunohistochemistry. References