BCG instillations can mimic prostate cancer on multiparametric MRI

Garrido-Abad, Pablo; Rodríguez-Cabello, Miguel Ángel; González-Gordaliza, C.; Vera-Berón, Roberto; Platas-Sancho, Arturo

doi:10.1590/s1677-5538.ibju.2017.0621

Cited by 4 publications

(9 citation statements)

References 5 publications

(7 reference statements)

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“…On high b-value diffusion-weighted MRI, the lesion of the case patient had a markedly hyperintense focus with a PI-RADS version 2 score of 5. Several other studies support our nding of a PI-RADS version 2 score of 5 [22,29,39]. However, Gottlieb et al [37] reported ve patients with granulomatous prostatitis whose abnormalities on high b-value diffusion-weighted MRI were of low signal.…”

Section: Discussionsupporting

confidence: 73%

“…With the inability to differentiate between granulomatous prostatitis and prostate cancer on transrectal ultrasound [23], speci c characteristics of BCG-induced granulomatous prostatitis on MP-MRI have been proposed recently. In the case patient, an abnormal focus showed low signal in T2-weighted images and an apparent diffusion coe cient in the peripheral zone, which has been reported previously [22,24,25,29,37]. These characteristics could occur because the histology of granulomatous prostatitis includes stromal in ltration of chronic in ammatory cells and extracellular uid surrounding the prostatic cells.…”

Section: Discussionsupporting

confidence: 68%

“…In two recent cases, elevated PSA levels ranging from 6.1 ng/ml to 8.4 ng/ml in patients with granulomatous prostatitis after BCG instillation [22,28]. In our patient, increasing total PSA levels and a decreasing ratio of free PSA/total PSA was found, which complicated the differentiation between prostate cancer and granulomatous prostatitis.…”

Section: Discussionmentioning

confidence: 47%

“…Several cases have reported that granulomatous prostatitis presents as increased serum levels of prostate-speci c antigen (PSA) and a node with an abnormal signal detected by multiparametric prostate magnetic resonance imaging (MP-MRI). Furthermore, previous cases involved nodular or diffusely rm enlargement on digital rectal examination, which was suggestive of prostate cancer and only resulted in a diagnosis of granulomatous prostatitis after prostate biopsy [22][23][24][25]. Here, we present a case of granulomatous prostatitis induced by BCG instillation and describe how to differentiate between granulomatous prostatitis induced by BCG instillation and prostate cancer.…”

Section: Introductionmentioning

confidence: 96%

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Granulomatous Prostatitis after Bacille Calmette-Guérin Instillation Resembles Prostate Carcinoma: A Case Report

Yao

Wang

et al. 2022

Preprint

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Background: 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. Case presentation: A 64-year-old Chinese man who was diagnosed with non-muscle-invasive bladder cancer received BCG instillation. Three days later, he was diagnosed with urinary tract infection. He stopped BCG instillation and received anti-infective therapy. BCG instillation was restarted 14 months later. Three months after BCG restart, he presented with rising levels of total prostate-specific antigen (PSA) (9.14 ng/mL) and a decreasing ratio of free PSA/total PSA (0.09). Digital rectal examination revealed a moderately enlarged, non-painful prostate gland with normal density. In multiparametric prostate magnetic resonance imaging (MRI), axial T2-weighted images showed a 28 mm × 20 mm diffuse abnormality with a low signal in the right peripheral zone. On diffusion-weighted MRI with a high b-value, the lesion was seen as a markedly hyperintense focus, which was consistent with a lesion with a Prostate Imaging Reporting and Data System score of 5, with a hypointense signal on an apparent diffusion coefficient map image. Considering the possibility of prostate cancer, a prostate biopsy was conducted. Histopathology showed benign prostate tissue with typical features of granulomatous prostatitis. The nucleic acid test for tuberculosis was performed and the result was positive. The patient was finally diagnosed with BCG-induced granulomatous prostatitis. Thereafter, he stopped BCG instillation again and received anti-tuberculosis treatment. During a follow-up visit after 10 months, the patient presented with no evidence of tumor recurrence or symptoms of tuberculosis. Conclusion: Although histopathology is the only way to accurately differentiate between BCG-induced granulomatous prostatitis and prostate cancer, 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.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Granulomatous Prostatitis after Bacille Calmette-Guérin Instillation Resembles Prostate Carcinoma: A Case Report

Yao

Wang

et al. 2022

Preprint

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“…Although the complications of intravesical BCG therapy are known, to the best of our knowledge few studies have examined the association between the radiological and pathological findings of the prostate after intravesical BCG therapy. Although several case studies have reported changes in the prostate on magnetic resonance imaging (MRI) following intravesical BCG therapy [5,6], there is no clear consensus whether they warrant prostatic biopsy (PBx).…”

Section: Introductionmentioning

confidence: 99%