Prostatic tuberculosis or Tuberculous prostatitis is an uncommon extrapulmonary manifestation of Mycobacterium tuberculosis.
Primary tuberculosis of the prostate is rare. Genitourinary tuberculosis contributes to 5-10% of extrapulmonary cases of tuberculosis in developed countries and 15-20% of cases in developing countries with 6.6% of all genitourinary tuberculosis involving the prostate 1-3.
Patients with tuberculous prostatitis usually present with urethral discharge, painful (sometimes blood-stained) ejaculation, mild ache in the perineum, infertility and dysuria 4.
The possible modes of metastasis include hematogenous, lymphatic or direct routes
- enlargement of the prostate gland
- solitary nodular (rare) or multiple hypoechoic areas of variable sizes within the gland.
- irregularity of the external contour of the prostate.
Transrectal ultrasound (TRUS)
- TRUS shows diffuse hypoechoic lesions within the peripheral zone of the prostate as the typical location is in the peripheral part of the posterior and lateral lobes of the prostate 2.
- color doppler interrogation shows increased vascularity in inflammatory phase of granulomatous prostatitis 5.
Characteristic MRI findings of prostatic tuberculosis have not been described due to the relative rarity of cases 3.
MRI appearance of prostate tuberculosis can be nodular or diffuse 3:
- T2: characterised by markedly low signal intensity, which is due to the paramagnetic substances such as macrophage-laden oxygen free radicals
- DWI: diffusion restriction
- T1C+: moderate enhancement on dynamic sequences
- T2: lower signal than that of the normal peripheral zone but not as low as that of nodular lesions. Diffuse streaky areas of low signal intensity on T2 (Watermelon skin sign)
- 1. Aziz, E. M., Abdelhak, K., & Hassan, F. M. (2016). Tuberculous prostatitis: mimicking a cancer. The Pan African Medical Journal, 25, 130. doi:10.11604/pamj.2016.25.130.7577 - Pubmed
- 2. Nitin Gupta, AK Mandal, SK Singh. Tuberculosis of the prostate and urethra: A review. (2008) Indian Journal of Urology. 24 (3): 388. doi:10.4103/0970-1591.42623 - Pubmed
- 3. Cheng Y, Huang L, Zhang X, Ji Q, Shen W. Multiparametric Magnetic Resonance Imaging Characteristics of Prostate Tuberculosis. Korean journal of radiology. 16 (4): 846-52. doi:10.3348/kjr.2015.16.4.846 - Pubmed
- 4. R. C. G. Russell, Norman S. Williams, Christopher J. K. Bulstrode. Bailey & Love's Short Practice of Surgery. ISBN: 9780340808191
- 5. N Bhargava, SK Bhargava. Primary tuberculosis of the prostate. (2003) Indian Journal of Radiology and Imaging. 13 (2): 236.