Prostatic tuberculosis or tuberculous prostatitis is an uncommon extrapulmonary manifestation of Mycobacterium tuberculosis infection.
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. 6.6% of all genitourinary tuberculosis involve 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 infective spread include haematogenous, lymphatic, or direct routes.
Findings include 5:
- 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
- colour Doppler interrogation shows increased vascularity in the 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.