Citation, DOI & article data
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)
- 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
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- 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.
- 6. Hellig JC, Reddy Y, Keyter M, Du Toit M, Adam A. Tuberculous prostatitis: a condition not confined to the immunocompromised. (2019) South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie. 57 (4): 43. Pubmed
- 7. Kulchavenya E, Brizhatyuk E, Khomyakov V. Diagnosis and therapy for prostate tuberculosis. (2014) Therapeutic advances in urology. 6 (4): 129-34. doi:10.1177/1756287214529005 - Pubmed
- 8. Bour L, Schull A, Delongchamps NB, Beuvon F, Muradyan N, Legmann P, Cornud F. Multiparametric MRI features of granulomatous prostatitis and tubercular prostate abscess. (2013) Diagnostic and interventional imaging. 94 (1): 84-90. doi:10.1016/j.diii.2012.09.001 - Pubmed