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) :

  • infectious granulomas

  • nonspecific granulomatous prostatitis

  • postbiopsy granulomas

  • 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 :

  • infectious granulomas

    • bacteria

      • Mycobacterium tuberculosis is the most common

        • may occur as a result of systemic/genitourinary tuberculosis or

        • more commonly, as a complication of bacillus Calmette-Guérin (BCG) immunotherapy for superficial bladder carcinoma

    • fungi

      • Blastomycosis, coccidioidomycosis, and cryptococcosis are the most common

    • parasites

    • viruses

  • nonspecific granulomatous prostatitis

    • ​blockage of prostatic ducts and stasis of secretions

  • postbiopsy granulomas

    • ​reaction to cautery and thermal alterations to prostatic epithelium and stroma

  • systemic granulomatous prostatitis

    • allergic granulomatous prostatitis

    • sarcoidosis

    • rheumatoid nodules

    • Churg-Strauss syndrome

    • Wegener granulomatosis

Presentation

In about 80% of the patients, there was a triad of

  • high fever followed by

  • symptoms of nonspecific prostatitis and

  • suggestion of a malignant prostate on rectal palpation.

Diagnosis

  • ​The prostate may feel hard and nodular on digital rectal examination, and cancer is usually suspected clinically.

  • The serum prostate-specific antigen (PSA) level may be elevated.

  • Hematuria and pyuria may be demonstrated on urine analysis.

Biopsy histopathology is required for final differentiation between granulomatous prostatitis and cancer.

  • Granulomas are localized collections of activated macrophages (epithelioid histiocytes), usually surrounded by a collar of lymphocytes.

  • The activated macrophages may fuse to form multinucleated giant cells.

Treatment

Treat symptomatically in the OOH setting, and refer to urologist for biopsy.

  • Empirical nonsurgical treatment will suffice in most cases if sufficient time is allowed for the inflammatory reaction to resolve.

  • 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

View/Access

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

View/Access

4. Rafique M, Yaqoob N.

Xanthogranulomatous prostatitis: a mimic of carcinoma of prostate.

World J Surg Oncol. 2006 Jun 5. 4:30.

View/Access

 

CPD Quiz and Certificate

This activity attracts 1,0 CPD point

Scroll down the box above to view its entire content

All users who successfully complete the quiz are e-mailed a copy of their personalised CPD certificate.