Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2051
Peer-review started: November 27, 2022
First decision: January 12, 2023
Revised: January 15, 2023
Accepted: March 1, 2023
Article in press: March 1, 2023
Published online: March 26, 2023
Processing time: 109 Days and 22.9 Hours
Bacille Calmette-Guérin (BCG) instillation is recommended in patients with non-muscle-invasive bladder cancer who have intermediate-risk and high-risk tumors. However, granulomatous prostatitis is a rare complication induced by BCG instillation, which can easily be misdiagnosed as prostate cancer. Here, we report a case of granulomatous prostatitis that resembled prostate cancer.
A 64-year-old Chinese man with bladder cancer received BCG instillation. Three days later, he stopped BCG instillation and received anti-infective therapy due to the urinary tract infection. Three months after BCG restart, he had rising total prostate-specific antigen (PSA) (9.14 ng/mL) and decreasing free PSA/total PSA (0.09). T2-weighted images of magnetic resonance imaging (MRI) showed a 28 mm × 20 mm diffuse low signal abnormality in the right peripheral zone, which was markedly hyperintense on high b-value diffusion-weighted MRI and hypointense on apparent diffusion coefficient map images. Considering Prostate Imaging Reporting and Data System score of 5 and possibility of prostate cancer, a prostate biopsy was conducted. Histopathology showed typical features of granulomatous prostatitis. The nucleic acid test for tuberculosis was positive. He was finally diagnosed with BCG-induced granulomatous prostatitis. Thereafter, he stopped BCG instillation and received anti-tuberculosis treatment. During 10 mo follow-up, he had no evidence of tumor recurrence or symptoms of tuberculosis.
Temporarily elevated PSA and high followed by low signal abnormality on diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.
Core Tip: Granulomatous prostatitis is a rare complication of BCG instillation, which can easily be misdiagnosed as prostate cancer. Here, we report a 64-year-old Chinese man with BCG-induced granulomatous prostatitis that resembles prostate cancer. Although histopathology remains the gold standard to accurately differentiate between the two diagnoses, some clues such as temporarily elevated PSA levels and a high signal followed by a low-signal abnormality on high b-value diffusion-weighted MRI are important indicators of BCG-induced granulomatous prostatitis.