Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2023; 11(9): 2051-2059
Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2051
Granulomatous prostatitis after bacille Calmette-Guérin instillation resembles prostate carcinoma: A case report and review of the literature
Yu Yao, Jun-Jie Ji, Hai-Yun Wang, Li-Jiang Sun, Gui-Ming Zhang
Yu Yao, Jun-Jie Ji, Hai-Yun Wang, Li-Jiang Sun, Gui-Ming Zhang, Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Author contributions: Zhang GM designed the study; Yao Y and Ji JJ collected, analyzed and interpreted the clinical data, and wrote the manuscript; Wang HY and Sun LJ collected part of the patients’ clinical data; Zhang GM supervised the project and revised the manuscript; all authors vouch for the respective data and analysis, approved the final version, and agreed to publish the manuscript.
Supported by the Natural Science Foundation of Shandong Province, No. ZR2021MH354.
Informed consent statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is approved by Ethics Committee of the Affiliated Hospital of Qingdao University.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Ming Zhang, MD, PhD, Doctor, Department of Urology, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao 266003, Shandong Province, China. zhangguiming9@126.com
Received: November 27, 2022
Peer-review started: November 27, 2022
First decision: January 12, 2023
Revised: January 15, 2023
Accepted: March 1, 2023
Article in press: March 1, 2023
Published online: March 26, 2023
Abstract
BACKGROUND

Bacille Calmette-Guérin (BCG) instillation is recommended in patients with non-muscle-invasive bladder cancer who have intermediate-risk and high-risk tumors. However, granulomatous prostatitis is a rare complication induced by BCG instillation, which can easily be misdiagnosed as prostate cancer. Here, we report a case of granulomatous prostatitis that resembled prostate cancer.

CASE SUMMARY

A 64-year-old Chinese man with bladder cancer received BCG instillation. Three days later, he stopped BCG instillation and received anti-infective therapy due to the urinary tract infection. Three months after BCG restart, he had rising total prostate-specific antigen (PSA) (9.14 ng/mL) and decreasing free PSA/total PSA (0.09). T2-weighted images of magnetic resonance imaging (MRI) showed a 28 mm × 20 mm diffuse low signal abnormality in the right peripheral zone, which was markedly hyperintense on high b-value diffusion-weighted MRI and hypointense on apparent diffusion coefficient map images. Considering Prostate Imaging Reporting and Data System score of 5 and possibility of prostate cancer, a prostate biopsy was conducted. Histopathology showed typical features of granulomatous prostatitis. The nucleic acid test for tuberculosis was positive. He was finally diagnosed with BCG-induced granulomatous prostatitis. Thereafter, he stopped BCG instillation and received anti-tuberculosis treatment. During 10 mo follow-up, he had no evidence of tumor recurrence or symptoms of tuberculosis.

CONCLUSION

Temporarily elevated PSA and high followed by low signal abnormality on diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.

Keywords: Granulomatous prostatitis, Prostate cancer, Bacille Calmette-Guérin, Magnetic resonance imaging, Prostate-specific antigen, Case report

Core Tip: Granulomatous prostatitis is a rare complication of BCG instillation, which can easily be misdiagnosed as prostate cancer. Here, we report a 64-year-old Chinese man with BCG-induced granulomatous prostatitis that resembles prostate cancer. Although histopathology remains the gold standard to accurately differentiate between the two diagnoses, some clues such as temporarily elevated PSA levels and a high signal followed by a low-signal abnormality on high b-value diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.