Tuberculosis of the prostate gland masquerading prostate cancer; five cases experience at IGIMS

Tuberculosis (TB) of the prostate is a very rare disease. Most urologists are not familiar with it. Here, we present our experience with five cases of this disease and a review of literature.

This is a retrospective study in a tertiary care center (IGIMS, Patna, Bihar, India) from January 2013 to February 2018.

All the patients were in their fourth to sixth decades of life. Lower urinary tract symptom was the most common presentation, predominantly irritative symptoms. A history of pulmonary TB was present in one case. Four out of five cases (80%) had a suspicious prostate on the digital rectal examination (DRE) (hard in consistency). Serum prostate-specific antigen (PSA) level was slightly elevated with a mean of 13.24 ng/ml. Urine analysis revealed sterile pyuria in all patients, and the urine culture was negative. The urine for acid-fast bacilli was positive in one case (20%). Mycobacterium tuberculosis culture test was positive in two cases (40%). The transrectal ultrasonogram showed hypoechoic areas with irregular outlines in three cases (60%) and calcification in two cases (40%). Histopathological examination showed chronic granulomatous prostatitis with few Langhans-type giant cells in four cases (80%). All patients were scheduled to receive 6 months of chemotherapy with isoniazid, rifampicin, and ethambutol or pyrazinamide.

TB of the prostate may present like cancer prostate with raised serum PSA and suspicious prostate on DRE; hence, a high index of suspicion with a wide range of investigations may be required to achieve a complete diagnosis of prostatic TB.