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Granulomatous prostatitis diagnosed during intravesical BCG treatment
Sezgin Okçelik1, Hasan Soydan1, İsmail Yılmaz2
1Clinic of Urology, Gülhane Military Medical Academy Haydarpaşa Hospital, İstanbul, Turkey.
Turkish Journal of Urology
|September 2, 2015
Summary
Intravesical BCG immunotherapy for bladder cancer can cause granulomatous prostatitis, mimicking cancer progression. Prompt diagnosis and antituberculosis treatment improved patient outcomes, highlighting the importance of considering this condition.
Area of Science:
- Urology
- Oncology
- Pathology
Background:
- A 70-year-old male with a history of bladder cancer developed carcinoma in situ (CIS).
- Initial intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) led to severe dysuria and treatment discontinuation.
- Elevated prostate-specific antigen (PSA) and abnormal digital rectal examination (DRE) prompted further investigation.
Purpose of the Study:
- To investigate the cause of elevated PSA and DRE abnormalities in a patient undergoing intravesical BCG therapy.
- To determine the relationship between BCG treatment side effects and potential misdiagnosis.
- To evaluate the efficacy of antituberculosis treatment for BCG-induced granulomatous prostatitis.
Main Methods:
- Histopathological examination of bladder biopsy.
- Prostate-specific antigen (PSA) level monitoring.
- Digital rectal examination (DRE).
- Tuberculin skin test (PPD) and QuantiFERON testing.
- Initiation of antituberculosis treatment.
Main Results:
- Histopathology revealed granulomatous prostatitis, not cancer progression.
- Antituberculosis treatment was initiated due to positive PPD and QuantiFERON tests.
- Following treatment, PSA levels decreased, and the patient's clinical status improved significantly.
Conclusions:
- Severe dysuria, sterile pyuria, abnormal DRE, and high PSA during intravesical BCG therapy should prompt consideration of granulomatous prostatitis.
- Histopathological diagnosis is crucial for differentiating granulomatous prostatitis from cancer recurrence or progression.
- Medical treatment for granulomatous prostatitis, including antituberculosis therapy, can lead to favorable patient outcomes.
