Granulomatous prostatitis following Bacillus Calmette-Guérin therapy

Area of Science:

• Urology
• Radiology
• Pathology

Background:

• Granulomatous prostatitis (GP) is a rare condition, affecting 0.65-1.5% of men with chronic prostatitis.
• Radiological findings of GP often mimic those of prostate adenocarcinoma, posing a diagnostic challenge.

Observation:

• Magnetic resonance imaging (MRI) may reveal diffuse or focal nodular low T2 signal.
• Diffusion-weighted imaging (DWI) can show high signal intensity with corresponding low apparent diffusion coefficient (ADC) values.
• Post-contrast imaging might demonstrate lesion enhancement or rim enhancement, suggestive of caseous necrosis or abscess formation.

Findings:

• The case involved a 70-year-old male with granulomatous prostatitis.
• The patient had a history of intravesicle bacillus Calmette-Guérin (BCG) administration.
• Overlapping imaging features between GP and prostate adenocarcinoma necessitate further investigation.

Implications:

• Suspicion of GP based on MRI requires biopsy for accurate diagnosis.
• Understanding these imaging characteristics aids in differentiating GP from prostate cancer.
• Prior intravesicle BCG administration is a relevant clinical context for GP presentation.