Xanthogranulomatous prostatitis mimicking prostate carcinoma: a case report and comprehensive literature review.

INTRODUCTION: Granulomatous prostatitis (GP) is a relatively uncommon disorder, accounting for approximately 0. 8% to 1.0% of all benign inflammatory prostatic conditions. Xanthogranulomatous prostatitis (XGP) is an exceptionally rare subtype of GP, with only a limited number of cases documented in the medical literature. Clinically and radiologically, this entity often mimics prostatic carcinoma, necessitating histopathological examination for an accurate diagnosis.

CASE PRESENTATION: A 69-year-old man presented with a multi-year history of urinary frequency, nocturia, dysuria, and dull flank pain. Clinical evaluation and laboratory studies revealed an elevated prostate-specific antigen (PSA) level. Ultrasonography demonstrated prostatic enlargement with heterogeneous echogenicity and a 1.7-cm intravesical protrusion. Prostate magnetic resonance imaging (MRI) indicated a prostatic volume of 46.33 cm3. A lesion measuring up to 2.4 cm in maximum diameter was localized to the right basal transitional zone and right basal fibromuscular stroma. The lesion exhibited low signal intensity on T2-weighted imaging, hyperintensity on diffusion-weighted imaging (DWI), and restricted diffusion with a correspondingly low signal on the apparent diffusion coefficient (ADC) map. Bladder involvement was also noted, yielding a Prostate Imaging Reporting and Data System (PI-RADS) score of 4. The patient subsequently underwent transurethral resection of the prostate (TURP) as a therapeutic intervention. Histopathological examination of the resected tissue confirmed the diagnosis of XGP.

CONCLUSION: XGP is an extremely rare prostatic pathology, and histopathological examination remains the gold standard for definitive diagnosis. Conservative management and TURP constitute the recommended therapeutic approaches for this condition.