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Case 258: Granulomatous Prostatitis.

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  • 1From the Departments of Radiology (A.D.d.L., D.N.C., I.P.), Urology (I.P.), and Pathology (F.F.), and the Advanced Imaging Research Center (D.N.C., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, 2nd Floor, Suite 202, Dallas, TX 75390-9085.

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A 68-year-old man with a history of urothelial carcinoma developed an elevated prostate-specific antigen (PSA) level. Subsequent MRI revealed a prostate lesion, prompting further investigation for potential prostate cancer.

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Area of Science:

  • Urology
  • Oncology
  • Radiology

Background:

  • A 68-year-old male patient with a history of high-grade urothelial carcinoma (renal pelvis) and recurrent low-grade urothelial carcinoma (bladder) was under surveillance.
  • The patient presented with no specific urinary symptoms or pain during routine evaluation.

Observation:

  • Routine surveillance MRI of the abdomen and pelvis identified a peripheral prostate zone lesion.
  • Elevated prostate-specific antigen (PSA) levels were noted (7.51 ng/mL).
  • The patient had no family history of prostate cancer and no prior prostate biopsies.

Findings:

  • MRI of the prostate with an endorectal coil was performed for further characterization of the identified lesion.
  • The findings suggest a potential new malignancy requiring further diagnostic workup.

Implications:

  • This case highlights the importance of vigilant surveillance in patients with a history of urothelial carcinoma.
  • Elevated PSA and incidental prostate lesions on imaging warrant thorough investigation, even in the absence of typical symptoms.
  • Early detection and characterization of prostate lesions are crucial for appropriate patient management.