Granulomatous prostatitis – an infrequent diagnosis

Abstract

Background : Granulomatous prostatitis is an unusual benign inflammatory process of the prostate. Clinically, it mimics prostatic carcinoma, thus requiring pathological examination for diagnosis. Materials and methods : Histopathological records of 1353 prostate specimens received in the Department of Pathology, Government Medical College, Chandigarh, India, over a period of 8 years (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) were reviewed and 20 cases of granulomatous prostatitis were retrieved. Results : Out of 20 cases of granulomatous prostatitis, we encountered 12 cases of non-specific granulomatous prostatitis, two cases of xanthogranulomatous prostatitis, two cases of tuberculous prostatitis, two cases of malakoplakia prostate and one case each of granulomatous prostatitis associated with adenocarcinoma prostate and post-surgical palisading granuloma. The diagnosis was made by histopathological examination of Trucut biopsy, transuretheral resection of prostate chips or retropubic prostatectomy specimen. In all the cases, granulomatous prostatitis was an incidental finding.Conclusions : Non-specific granulomatous prostatitis is the most common type of granulomatous prostatitis. Despite tuberculosis being very common in India, granulomatous prostatitis associated with tuberculosis is not common. Distinction between non-specific and infectious granulomatous prostatitis is important for therapeutic reasons.

A rare case of granulomatous prostatitis caused by Mycobacterium tuberculosis

“…It is also well described that in patients with granulomatous prostatitis, the prostate gland is clinically firm and nodular on digital rectal examination and mimics carcinoma. 2,3,7,8,15 Our patient had similar findings on clinical examination.…”

“…Whereas areas of abnormal low echogenicity occur in the prostate in granulomatous prostatitis, they do not occur in any characteristic pattern to differentiate them from carcinoma. 2,3,8,13 Naik and Carey reported the TRUS and MRI appearances of granulomatous prostatitis in 10 patients but did not find a correlation between the 2 imaging modalities in the diagnosis of focal abnormalities in the prostate gland. 3 One of their patients had a history of tuberculosis and extensive prostatic calcifications on TRUS.…”

“…[4][5][6] Nonspecific granulomatous prostatitis is the most common type, accounting for 60-80% cases of granulomatous prostatitis as reported in the literature. [6][7][8] Infective granulomatous prostatitis can be caused by Mycobacterium tuberculosis, nontuberculous mycobacteria, Treponema pallidum, viruses, and fungal organisms. [9][10][11] …”

An update on lower urinary tract tuberculosis

“…Clinically it is indistinguishable from prostatic carcinoma, and it can coexist with prostate cancer. In one series, tuberculous prostatitis was diagnosed from transurethral resection of the prostate (TURP) specimens in two patients, 50 and 52 years old, respectively, with hard, fi xed prostates and elevated PSA (12.2 ng/mL, 16.6 ng/mL) who presented with irritative voiding symptoms [ 18 ]. Another case report describes an 81-year-old white man with an indurated testis and nodular prostate.…”

Granulomatous prostatitis diagnosed during intravesical BCG treatment

“…Rectal examinations disclose abnormality specific to prostatitis. [6,7] Diagnosis of prostatitis is made with histopathological examination of the biopsy specimens retrieved because of suspect prostate cancer. In our case, diagnosis was made by histopathological examination of the prostate biopsy specimens harvested because of suspect prostate cancer after detection of increased PSA levels, and abnormal DRE findings.…”