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Urology
Xanthogranulomatous prostatitis: benign prostate infection masquerading as invasive prostate cancer on MRI and PET-PSMA
  1. Kenneth Keen Yip Chew1,2,
  2. Brianna Thompson3,
  3. Mahtab Farzin3,4 and
  4. Eddy Lee Hao Wong2,5
  1. 1Department of Surgery, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Urology, Liverpool Hospital, Liverpool, New South Wales, Australia
  3. 3Department of Anatomical Pathology, Liverpool Hospital, Liverpool, New South Wales, Australia
  4. 4Western Sydney University, Parramatta, New South Wales, Australia
  5. 5Campbelltown Hospital, Campbelltown, New South Wales, Australia
  1. Correspondence to Kenneth Keen Yip Chew; kennethkychew{at}gmail.com

Abstract

Xanthogranulomatous prostatitis (XGP) is a rare inflammatory condition that can closely mimic prostate adenocarcinoma both clinically and radiologically. We report the case of a man in his mid-60s who presented with pelvic discomfort, dysuria, reduced urine flow and fever. He had an elevated prostate-specific antigen (PSA) level of 17.5 ng/mL and abnormal findings on digital rectal examination. Multi-parametric MRI of the prostate revealed a prostate lesion suspicious for malignancy invading the rectal wall and right obturator internus muscle. However, transperineal prostate biopsies confirmed XGP with no evidence of cancer. The patient was treated with a 4-month course of ciprofloxacin, which resolved most of his symptoms, and alpha-blocker therapy was commenced to improve urine flow. This case emphasises the diagnostic challenges posed by XGP, which can mimic T4 prostate cancer and potentially lead to overtreatment. Awareness of this condition, along with systematic diagnostic strategies, is essential to avoid unnecessary interventions and optimise patient management.

  • Prostate
  • Urinary tract infections

https://doi.org/10.1136/bcr-2025-265543

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    Footnotes

    • Contributors KKYC is the guarantor and contributed to the conceptualisation, methodology, project administration, visualisation, writing of the original draft preparation, writing, reviewing and editing. BT contributed to the conceptualisation, resources, visualisation, writing, review and editing. MF contributed to the resources, supervision, writing, reviewing and editing. ELHW contributed to the supervision, writing, reviewing and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.