Clinical Notes : Urology
105. Granulomatous Prostatitis

Definition
Granulomatous prostatitis is a distinct clinical and pathological entity,
apparently a reaction to extravasated prostatic secretions into the surrounding tissues secondary to obstruction and infection within the prostate (1)
It is subclassified as (2) :
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infectious granulomas
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nonspecific granulomatous prostatitis
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postbiopsy granulomas
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systemic granulomatous prostatitis


Etiology (3):
Granulomatous prostatitis accounts for fewer than 1% of benign inflammatory conditions of the prostate.
Nonspecific granulomatous prostatitis accounts for most cases of granulomatous prostatitis - up to 70% (4)
Age range from 18 to 86 years; with mean and median age of 62 years.
Causative agents include :
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infectious granulomas
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bacteria
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Mycobacterium tuberculosis is the most common
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may occur as a result of systemic/genitourinary tuberculosis or
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more commonly, as a complication of bacillus Calmette-Guérin (BCG) immunotherapy for superficial bladder carcinoma
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fungi
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Blastomycosis, coccidioidomycosis, and cryptococcosis are the most common
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parasites
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viruses
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nonspecific granulomatous prostatitis
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blockage of prostatic ducts and stasis of secretions
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postbiopsy granulomas
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reaction to cautery and thermal alterations to prostatic epithelium and stroma
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systemic granulomatous prostatitis
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allergic granulomatous prostatitis
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sarcoidosis
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rheumatoid nodules
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Churg-Strauss syndrome
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Wegener granulomatosis
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Presentation
In about 80% of the patients, there was a triad of
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high fever followed by
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symptoms of nonspecific prostatitis and
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suggestion of a malignant prostate on rectal palpation.
Diagnosis
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The prostate may feel hard and nodular on digital rectal examination, and cancer is usually suspected clinically.
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The serum prostate-specific antigen (PSA) level may be elevated.
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Hematuria and pyuria may be demonstrated on urine analysis.
Biopsy histopathology is required for final differentiation between granulomatous prostatitis and cancer.
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Granulomas are localized collections of activated macrophages (epithelioid histiocytes), usually surrounded by a collar of lymphocytes.
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The activated macrophages may fuse to form multinucleated giant cells.
Treatment
Treat symptomatically in the OOH setting, and refer to urologist for biopsy.
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Empirical nonsurgical treatment will suffice in most cases if sufficient time is allowed for the inflammatory reaction to resolve.
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This seldom requires more than three months

1. Panayotis P. Kelalis, Laurence F. Greene, Edgar G. Harrison Jr.
Granulomatous ProstatitisA Mimic of Carcinoma of the Prostate
JAMA. 1965;191(4):287-289
2. Epstein JI, Netto GJ. Inflammatory conditions. Epstein JI, ed.
Biopsy Interpretation of the Prostate.
4th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. 22-34
3. Srigley JR.
Benign mimickers of prostatic adenocarcinoma.
Mod Pathol. 2004 Mar. 17(3):328-48
4. Rafique M, Yaqoob N.
Xanthogranulomatous prostatitis: a mimic of carcinoma of prostate.
World J Surg Oncol. 2006 Jun 5. 4:30.

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