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Prostatic tuberculosis or tuberculous prostatitis is an uncommon extrapulmonary manifestation of Mycobacterium tuberculosis infection. This is sometimes classified a sub type of granulomatous prostatitis.
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 hematogenous, lymphatic, or direct routes.
There may be a more common association with HIV-infection, than in pulmonary tuberculosis.
- prostate specific antigen (PSA): can be less than 4.0 ng/ml ~ 80 % of cases 7.
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
- color 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: characterized 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)
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