What question did this study set out to answer?

To highlight the misdiagnosis of prostatic malakoplakia as prostate cancer due to similar presentations.

March 10, 2026Urology Case Reports0 citationsOpen Access

Prostatic Malakoplakia Mimicking Prostate Cancer in an Elderly Male with Prostatitis: A Rare but Important Differential

MRM. Rosario DSD. Sitharthan WDW. Delprado

Key Points

To highlight the misdiagnosis of prostatic malakoplakia as prostate cancer due to similar presentations.
Case report of an 81-year-old male with lower urinary tract symptoms and elevated PSA
MRI to evaluate a PIRADS 5 lesion in the left transition zone
Histopathological evaluation after transperineal biopsy
Initial PSA level of 39 ng/mL normalized after antibiotic treatment
MRI indicated a suspicious lesion consistent with prostate cancer
Biopsy confirmed the presence of prostatic malakoplakia instead of cancer

Abstract

We report the case of an 81-year-old male presenting with lower urinary tract symptoms and a PSA of 39 ng/mL, initially attributed to Escherichia coli prostatitis. Despite PSA normalization with antibiotics, MRI demonstrated a PIRADS 5 lesion in the left transition zone. Histopathological evaluation following transperineal biopsy revealed prostatic malakoplakia. This rare granulomatous condition can mimic prostate cancer both clinically and radiologically. Our case highlights the importance of histological confirmation in atypical presentations to avoid misdiagnosis and overtreatment.

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