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

Objectives: 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. Materials and Methods: This is a retrospective study in a tertiary care center (IGIMS, Patna, Bihar, India) from January 2013 to February 2018. Results: 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. Conclusion: 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.