Diagnosis and therapy for prostate tuberculosis

Abstract

In its 2012 global report on tuberculosis, the World Health Organization estimated that 3-7% (range 2.1-5.2%) of new cases and 20% (range 13-26%) of previously treated cases had multidrug-resistant tuberculosis (defined as tuberculosis caused by Mycobacterium tuberculosis isolates that are resistant to rifampicin and isoniazid). In many countries in Eastern Europe and central Asia, 9-32% of new patients and more than 50% of previously treated patients have multidrug-resistant tuberculosis. Ninety-three patients with suspected prostate tuberculosis were enrolled in this study and all underwent prostate biopsy. This method allowed confirmation of diagnosis in 32 patients (34.4%): 23 by histology, six by culture and five by polymerase chain reaction (PCR) (among them, two also had positive culture). The efficiency of an optimized scheme for the therapy of prostate tuberculosis (the second part of the study) was estimated in 53 patients. The first group (25 patients) was treated with a standard scheme of chemotherapy; the second group (28 prostate tuberculosis patients) received ofloxacin in addition for 2 months during the intensive phase. The phase continuation in both groups was identical, with rifampicin and isoniazid administered for 6 months. Optimization of the standard therapy by additional administration of ofloxacin improved results of the treatment in 33.8% of patients.

Tuberculous prostatitis: a condition not confined to the immunocompromised

“…5 Prostatic specimens may be examined by histopathology, polymerase chain reaction (PCR) for mycobacterial detection, culture and stains for AFBs. 7,8 The characteristic lesion is confluent foci of caseous necrosis surrounded by epithelioid histiocytes. However, as in our case, the absence of caseation on biopsy does not necessarily exclude TB prostatitis.…”

“…5 Voiding cystourethrogram with retrograde urethrogram may reveal filling defects suggestive of TB cavities. 8 Important benign mimickers of prostate cancer which give rise to false-positive malignant cells are prostatic atrophy, post-atrophic hyperplasia, atypical adenomatous hyperplasia and seminal vesicle tissue. Inflammatory processes such as granulomatous prostatitis, xanthogranulomatous prostatitis and malakoplakia may simulate high grade adenocarcinoma.…”

Evaluation of the efficacy of post prostatic massage urine cytology in diagnosis of various prostatic lesions with cytohistological and clinical correlation

“…Mycobacterial infection of prostate causing granulomatous prostatitis can occur following miliary tuberculosis and the diagnosis can be confirmed by demonstration of acid fast bacilli on prostatic tissue, by culture, and polymerase chain reaction of prostatic fluid. [ 8 9 ] Diagnosis of prostatic calculi was made in two cases (4%) belonging to clinically suspicious group. Both the cases were confirmed radiologically and had normal levels of acid and alkaline phosphatases.…”

Treatment of Bacterial Prostatitis: Clinico-Pharmacological Considerations

“…Kulchavenya and Khomyakov showed that standard chemotherapy for PTB is only partially effective, since only 22.8 % of patients were found to be cured with regimens including isoniazid, rifampicin, pyrazinamide, and streptomycin, the disease becoming chronic and progressive in the remaining 77.2 % of cases [ 30 ]. However, a cohort study by the same research group has demonstrated that a pharmacological protocol based on isoniazid (10 mg/kg), pyrazinamide (25 mg/kg), streptomycin (1,000 mg intramuscular), rifampicin (10 mg/kg), and the fl uoroquinolone ofl oxacin (10 mg/kg), administered during the "intensive phase" of therapy and eventually switched to a rifampicin-isoniazid combination for 6 months, resulted in undetectable Mycobacteria and disappearance of pain, dysuria, and pyospermia in 78 % of cases [ 29 ]. Interestingly, this outcome could be achieved only in 44 % of control patients who received the same regimen not including ofl oxacin [ 29 ].…”

“…However, a cohort study by the same research group has demonstrated that a pharmacological protocol based on isoniazid (10 mg/kg), pyrazinamide (25 mg/kg), streptomycin (1,000 mg intramuscular), rifampicin (10 mg/kg), and the fl uoroquinolone ofl oxacin (10 mg/kg), administered during the "intensive phase" of therapy and eventually switched to a rifampicin-isoniazid combination for 6 months, resulted in undetectable Mycobacteria and disappearance of pain, dysuria, and pyospermia in 78 % of cases [ 29 ]. Interestingly, this outcome could be achieved only in 44 % of control patients who received the same regimen not including ofl oxacin [ 29 ]. Being PTB a rare disease, it is perhaps unrealistic to expect confi rmation of these interesting results in a randomized setting.…”