Challenges of Prostatic Tuberculosis: When Infection and Neoplasia Coexist

Extrapulmonary tuberculosis (TB) accounts for 15%-20% of all TB cases, with genitourinary involvement being one of the less common forms. Prostatic TB is a rare entity that often presents nonspecific symptoms and is frequently diagnosed incidentally during histopathological examination. We present the case of a 55-year-old man who sought care for persistent urinary symptoms, including dysuria, pollakiuria, straining, and bladder tenesmus. Laboratory studies showed elevated prostate-specific antigen levels. Ultrasound imaging demonstrated changes suggestive of chronic prostatitis. Subsequently, a histopathological study of a prostate biopsy with Ziehl-Neelsen staining reported the focal presence of acid-fast bacilli, a finding suggestive of prostatic TB. Prostatic TB is a rare form of genitourinary TB that can clinically mimic benign processes such as benign prostatic hyperplasia or chronic urinary tract infections. Its diagnosis requires a high index of suspicion and histopathological confirmation. In this case, the pathological study was definitive. This report highlights the importance of considering prostatic TB as a differential diagnosis in patients with chronic urinary symptoms and a poor response to conventional antibiotics, especially in areas endemic for TB.