Granulomatous prostatitis

Granulomatous prostatitis is a nodular form of chronic prostatitis. It is usually diagnosed on biopsy.

Pathology

Causes

• idiopathic

• infection

  • tuberculous prostatitis

• iatrogenic

  • Bacillus Calmette–Guérin (BCG) vaccine

  • intravesical BCG therapy for bladder cancer

  • post-radiotherapy

• systemic disease

  • sarcoidosis

  • autoimmune

Subtypes

Several classification systems exist. A frequently used classification specifies the following subtypes:

• non-specific granulomatous prostatitis (NSGP): considered one of the commonest subtypes ^4,5

• infectious

• indeterminate

An alternate classification system has also been described:

• non-specific granulomatous prostatitis

• tubercular granulomatous prostatitis - prostatic tuberculosis

• postsurgical granulomatous prostatitis

• allergic granulomatous prostatitis

• xanthogranulomatous prostatitis

Histology

Histological appearances are related to the underlying subtype ⁷.

Radiographic features

General features

Often there is no definite imaging finding to allow the diagnosis of granulomatous prostatitis to be made or, indeed, to differentiate it from prostatic carcinoma ². The diagnosis should always be made histologically.

Widening of the prostatic urethra, however, may be a useful feature in differentiation from cancer ¹.

Ultrasound

Ultrasound findings are divided into a hypoechoic nodule (~70%) or a diffusely hypoechoic peripheral zone (~30%).

MRI

Three morphological MRI patterns have been described which are diffuse, nodular (tumor-like), and cystic with mural nodule ³.

Signal characteristics include:

• T2: affected regions hypointense

• C+ (Gd): no enhancement following Gd-DTPA

Management and prognosis

Patient should be followed up till complete resolution of imaging changes to ensure a prostate cancer has not been masked.

History and etymology

It was first described by F H Tanner and J R McDonald in 1943 ¹³.