Tuberculosis of the Prostate Gland Masquerading Prostate Cancer: A Case Report

doi:10.4236/oju.2013.37050

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Open Journal of Urology, 2013, 3, 269-271

Published Online November 2013 (http://www.scirp.org/journal/oju)

http://dx.doi.org/10.4236/oju.2013.37050

Open Access OJU

Tuberculosis of the Prostate Gland Masquerading

Prostate Cancer: A Case Report

Sani Ali Aji1*, Sani Usman Alhassan1, Sharfuddeen Abbas Mashi1, Muhammad Ibrahim Imam2

1Urology Unit, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria

2Department of Pathology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria

Email: *[email protected]

Received September 25, 2013; revised October 21, 2013; accepted October 28, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Tuberculosis is one of the most important infectious diseases, particularly in developing countries. Involvement of the

prostate gland is very rare. We present a 70-year-old man who presented with low back pain and progressive weakness

of the lower limbs associated with irritative lower urinary tract symptoms. Prostate glan d was enlarged, hard and nodu -

lar. Prostate specific antigen was 6 ng/ml, Erythrocytes sedimentation rate was 130 mm/hr and Monteux was positive.

Prostate biopsy revealed features of tuberculosis and lumbosacral radiograph revealed features of Pott’s disease. Diag-

nosis of disseminated tuberculosis with prostate involvement was made and patient was placed on anti-tuberculosis

drugs with good response.

Keywords: Disseminated Tuberculosis; Prostate Gland; Diagnosis

1. Introduction

Tuberculosis is one of the most important infectious dis-

ease, particularly in developing countries like Nigeria.

Approximately one third of the world population is in-

fected with tuberculosis [1]. It has been estimated that

the genus “mycobacteria” causes more suffering for the

humans than all the other bacterial genera combined [2].

Pulmonary tuberculosis is the most common form of

the disease and comprises of 68.4% of all cases, 20% to

25% of cases are extrapulmonary, while only 27% of the

extrapulmonary tuberculosis involves the genitourinary

system [3]. Tuberclosis of the prostate gland is seen in

only 2.6% of genitourinary tuberculosis [1].

Tuberculosis involving the prostate gland, apart from

being rare, can also mimic cancer of the prostate as well

as BPH and therefore requires a high index of suspicion.

Here we present a case of disseminated tuberculosis

involving the spine and the prostate gland, thereby mas-

querading as prostate cancer.

2. Case Report

A 70-year-old man was referred to our clinic with a

working diagnosis of prostate carcinoma from General

outpatient department of our hospital.

He presented with low back pain for 11 months and

inability to walk for 1 month. He had associated irritative

lower urinary tract symptoms but no obstructive symp-

toms. No history of haematuria. No history of trauma.

No history of fever, cough, contact with a person with

chronic cough or excessive night sweats, however he had

anorexia and progre ssi ve weight loss.

On examination, he was found to be an elderly man on

a wheelchair, he was not pale, afebrile, not dehydrated,

no significant peripheral lymphadenopathy and no pedal

oedema. Chest, cardiovascular and abdominal examina-

tions were essentially normal, however on rectal exami-

nation; the prostate was enlarged, hard and nodular. Power

on both lower limbs was 3/5. There was no sensory im-

pairment. Examination of the spines did not reveal any

abnormality.

His serum urea, electrolytes and creatinine were within

normal limits. Prostate specific antigen was 6 ng/ml.

Erythrocytes sedimentation rate was 130 mm/hr and Man -

teux test was positive. Prostatic biopsy revealed poorly

preserved prostatic tissue with few acini, the abundant

fibromascular stroma shows predominantly caseous ne-

crosis, occational “horse-shoe” shaped multinucleated g ia nt

cells and lymphocytic infiltrates (Figures 1 and 2). Lumbo-

sacral radiographs reveal reduction of space—L1/L2,

*Corresponding author.

S. A. AJI ET AL.

270

Figure 1. Show ing caseous necrosis, occational “horse-shoe”

shaped multinucleated giant cells and lymphocytic infil-

trates (40× magnification).

Figure 2. At lower magnification showing the same (10×

magnification).

L3/L4; with osteolytic changes, reduction in height of L5

and wide spr ead osteophytes (Figures 3 and 4). Chest x-

ray was normal.

Based on the above findings, diagnosis of Dissemi-

nated Tuberculosis was made; patient was also reviewed

by Orthopedic Surgeon and was then commenced on

anti-tuberculosis drugs with good response.

3. Discussion

Tuberculosis (TB) remains a major public health problem

in developing countries [4]. It can involve any organ sys-

tem, however when it involves two or more organ system,

it is referred to as Disseminated Tuberculosis (DTB) [2].

Involvement of the prostate gland is very rare, but can

occur either in isolation, [5] with other Genitourinary

organs like epididymis and seminal vesicle, or as part of

a DTB [2].

TB involving the prostate may be very difficult to dif-

ferentiate from the carcinoma of the prostate, particularly

Figure 3. Showing reduction of space—T12/L1 with oste-

olytic changes.

Figure 4. Showing reduction in height of L5 and wide

spread osteophytes.

Open Access OJU

S. A. AJI ET AL.

Open Access OJU

271

when prostate is hard and nodular on digital rectal ex-

amination [6]. Prostate TB is mainly diagnosed inciden-

tally, either following trucut needle biopsy of the prostate

for a suspected carcinoma of the prostate, [7] or after

prostatectomy specimen for Benign Prostatic Hyperplasia

is subjected to histology [8]. Very rarely prostate cancer

can co-exist with TB of the Prostate [9].

In this case report, the patient was initially seen by a

Family Physician, who made a diagnosis of metastatic

carcinoma of the Prostate based on the Paraparesis, and

the findings of a hard nodular prostate on rectal examina-

tion.

K. Huang et al. in Taiwan, conducted a study on 10

patients over a period of 10 years, who all presented with

digital rectal examination findings suggestive of Prostate

cancer, but needle biopsy of the prostate revealed tuber-

culosis [6].

A. Kostakopoulos et al. also presented 5 cases of TB

of the prostate, all of which were incidental histologic

findings after Trans-urethral resecti on of the Prostate [10].

P. M. Karup et al. and M. A. Gafur et al. have all pre-

sented a patient with lower urinary tract symptoms and

prostate biopsy revealed granulomatous prostatitis [11,

12].

We presented this case because it masqueraded as a

typical case of metastatic carcinoma of the prostate and

was only revealed after prostatic biopsy was done.

4. Conclusion

Tuberculosis of the prostate, though rare, can mimic p ros-

tate cancer as well as BPH. A high index of suspicion is

therefore needed in order to avoid misdiagnosis particu-

larly those practicing in the develop ing countries.

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