Granulomatous prostatitis following BCG therapy presenting as a PI-RADS 5 lesion on MRI in the transitional zone: A...

Granulomatous prostatitis is a rare benign inflammatory condition that may closely mimic prostate cancer on imaging. We report the case of a 71-year-old man who developed granulomatous prostatitis following intravesical Bacillus Calmette-Guérin (BCG) therapy for non-muscle-invasive bladder cancer. Post-treatment PSA elevation, prompted multiparametric MRI, which revealed a PI-RADS 5 lesion in the transitional zone of prostate- a rare location for such lesions. Targeted transperineal biopsy confirmed non-specific granulomatous prostatitis, with PCR analysis detecting Mycobacterium tuberculosis complex DNA. This case underscores the diagnostic challenge of distinguishing granulomatous prostatitis from prostate cancer, particularly in patients with a history of Bacillus Calmette-Guérin (BCG) therapy.