An improbable trifecta: Occurrence of xanthogranulomatous prostatitis, prostate cancer, and prostatic abscess in a single patient

Abstract

Xanthogranulomatous prostatitis (XGP) is a rare disease that can mimic the clinical and imaging findings of prostate cancer. Differentiation of these diseases is vital in order to offer the correct treatment. Histological examination of prostate tissue is the definitive manner in which XGP is distinguished from prostate cancer. This case demonstrates the rare possibility of concurrent findings of prostate abscess, prostate cancer, and XGP, further clouding diagnostic assessment. Percutaneous aspiration and antibiotic treatment of the abscess reduced lower urinary tract symptoms and eliminated XGP on subsequent prostate biopsy. Careful work up is necessary to prevent unnecessary interventions or missed diagnoses.

Granulomatous and xanthogranulomatous prostatitis: A case report

“…Follow-up should include measurements of PSA and, if necessary, needle biopsy of the prostate. 4 In the present patient, PSA became normal after treatment with antibiotics.…”

“… 3 A concomitant XGP may even coexist with a prostate abscess and prostate cancer in the same patient. 4 Hence, XGP can be confirmed only by histopathological examination. It is treated mainly by supportive therapy, with TURP performed in patients with severe lower urinary tract obstruction.…”

“…Granulomatous prostatitis and poorly differentiated carcinoma can be reliably distinguished by immunohistochemical methods. 4 XGP is distinguished from other, similar conditions by the presence of large numbers of “foamy macrophages “(histiocytes) that form granulomas. Other inflammatory cell infiltrates (Lymphocytes and plasma cells) may be present but are non-specific; present in other chronic inflammatory prostatic conditions.…”

“…Other inflammatory cell infiltrates (Lymphocytes and plasma cells) may be present but are non-specific; present in other chronic inflammatory prostatic conditions. 4 …”