Case Report: Xanthogranulomatous prostatitis, a difficult differential diagnosis of prostate adenocarcinoma

Abstract

Background: Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Clinical, biochemical and imaging similarities make xanthogranulomatous prostatitis a difficult differential diagnosis of prostatic adenocarcinoma. Case presentation: We report the case of a 62 year-old diabetic patient, with 3 months of lower urinary tract symptoms. On digital rectal examination, the prostate was hard and nodular. Initial prostate-specific antigen (PSA) was 43.97 ng/mL, with urine analysis and transabdominal ultrasonography not showing any alterations. A multiparametric magnetic resonance imaging (mpMRI) of the prostate was performed and showed two foci that were classified as PI-RADS 4 lesions. A transrectal ultrasound guided prostate biopsy was then realized. After an initial suspicion of prostatic adenocarcinoma, on clinical, biochemical and radiological grounds, histopathological examination revealed a suppurated xanthogranulomatous prostatitis, with no evidence of malignancy. Conclusions: Xanthogranulomatous prostatitis is an uncommon benign inflammatory condition of the prostate that can clinically, biochemically and even radiologically simulate prostatic adenocarcinoma. We advise that if an older male with low urinary tract symptoms and a hard nodular prostate on digital rectal examination presents, the first diagnosis that one should think of is prostate adenocarcinoma, especially if PSA is high. However, only histopathological examination can differentiate with certitude between these two pathologies and is therefore essential for the diagnosis of xanthogranulomatous prostatitis.

Xanthogranulomatous Prostatitis: Novel Presentation of a Rare Condition

“…Granulomatous inflammation is classified as nonspecific or idiopathic, infective, iatrogenic, xanthogranulomatous, malacoplakia, or associated with systemic granulomatous disease and allergy [ 2 , 3 , 8 ]. Of the various forms of inflammation of the prostate, the nonspecific type is the most common, and granulomatous is rare.…”

“…On physical examination, the prostate is usually hard and nodular [ 5 ]. The PSA level is typically elevated, as high as 150 ng/mL [ 1 – 5 , 8 ]. Imaging such as transrectal ultrasound and MRI cannot distinguish between xanthogranulomatous prostatitis and primary prostatic malignancy [ 5 ].…”

“…The diagnosis of xanthogranulomatous prostatitis can only be made definitively by pathological examination [ 6 ]. Theorized potential infectious causes of xanthogranulomatous prostatitis include types of fungi, parasites, viruses, Escherichia coli , Treponema pallidum , and Mycobacterium tuberculosis [ 2 , 4 , 8 ]. Conservative management is recommended for xanthogranulomatous prostatitis, including use of alpha blockers and corticosteroids.…”

“…The presentation typically involves lower urinary tract symptoms or symptoms of a lower urinary tract infection (UTI), including possible urethral discharge. The prostate-specific antigen (PSA) level is typically elevated, as high as 150 ng/mL [ 3 – 5 , 8 ]. Imaging such as transrectal ultrasound and magnetic resonance imaging (MRI) cannot distinguish between xanthogranulomatous prostatitis and primary prostatic adenocarcinoma [ 5 ].…”

Estudio comparativo de la síntesis de nanopartículas de magnetita monodispersas

“…Cuando consideramos nanopartículas debido su reducido tamaño, estas muestran una energía asociada que hace que determinadas distribuciones catiónicas desordenadas correspondientes a una estructura espinela mixta (directa e inversa), sean estables [9]. Considerando que estás partículas monodominio (partículas que debido a su reducido tamaño no es energéticamente favorable la formación de paredes de Bloch), mostrando un comportamiento superparamagnetico arriba de la temperatura de bloqueo (TB) [10].…”