Efficacy of chemotherapy for prostatic tuberculosis-a clinical and histologic follow-up study

To characterize the clinical features of prostatic tuberculosis and to evaluate the short and long-term results of antituberculous chemotherapy.

Eighteen patients (mean age 66.7 +/- 10.2 years) with prostatic tuberculosis were included in this study. The median pretreatment prostate-specific antigen (PSA) level was 2.7 ng/mL (range 0.3 to 31). The PSA level was greater than 4.0 ng/mL in 6 patients (33.3%). Eight patients (44.4%) received a triple-drug regimen of rifampin, ethambutol, and isoniazid for more than 6 months. The mean duration of chemotherapy was 7.6 months (range 6 to 12). Of the 8 patients, 3 underwent chemotherapy longer because of concurrent tuberculosis of other organs. Follow-up studies included digital rectal examination, total PSA determination, and transrectal prostate biopsy.

Ten patients were eligible for regular follow-up. All the patients were symptom free during follow-up. The median length of follow-up was 3.4 years (range 1 to 9). The average number of follow-up transrectal prostate biopsies was 2.4 (range 2 to 3). The follow-up histologic findings showed nodular hyperplasia in 7 patients and chronic inflammatory cell infiltration in 3 patients. No acid-fast bacillus was found in any follow-up specimen. Similarly, subsequent transrectal biopsy showed no relapse after a median length of 3.4 years of follow-up. Of the 6 patients with elevated PSA levels, the post-treatment PSA returned to normal in 3 patients.

Our results suggest that a triple-drug regimen of 6 months' duration can successfully control prostatic tuberculosis. Histologic follow-up is a good method for monitoring the efficacy of treatment. Transrectal prostate biopsy is an important tool for the diagnosis and follow-up of prostatic tuberculosis.