Granulomatous prostatitis: Clinicopathological overview and review of the literature

Introduction and objectives: It is challenging to rule out granulomatous prostatitis (GP), an uncommon inflammatory condition of the prostate, from prostate cancer. This study aims to characterize the clinical presentation, diagnostic evaluation and available treatment options for patients who present with GP.
Methods: This is a retrospective descriptive analysis of GP cases presented to a tertiary care urological referral center in Sri Lanka over a period of five years. Their demographic data, clinical presentation, examination findings, biochemical investigations, imaging and histopathological findings were collected from the patients’ records.
Results: Nine pathologically confirmed GP cases were found among the 1568 prostate specimens examined. They had an age range of 43–75 years, with a median age of 59 years. The majority of patients presented with acute urinary retention and found hard nodular prostates in a digital rectal examination (DRE). Their prostate-specific antigen (PSA) level ranged from 0.2 - 77.1 ng/ml, with a mean value of 30.66 ng/ml. Biochemical and histological evaluation revealed non-specific GP (NSGP) in five patients, suppurative GP in two patients, tubercular GP in one patient, and allergic GP in one patient.
Conclusions: GP is an uncommon condition in urological practice. Its presentation can mimic prostate cancer and is inevitably a diagnostic challenge for urologists, radiologists, and pathologists. Proper clinicopathological evaluation is the cornerstone of preventing overtreatment.