Granulomatous prostatitis as a complication of BCG intravesical instillation. Report of a case

OBJECTIVES: Herein we describe a case of granulomatous prostatitis following intravesical instillation of bacillus Calmette-Guerin (BCG) for superficial bladder cancer. METHODS: Patient evaluation included DRE, urine culture, urinary cytology, cystoscopy, PSA determination and transrectal US-guided needle biopsy. RESULTS: On control evaluation two months after intravesical BCG therapy had concluded, the patient referred an episode of suprapubic pain. DRE disclosed an area of increased hardness in one of the prostatic lobes. Urine staining for Mycobacterium was negative and PSA value was 3.5 ng/dl. During transrectal US evaluation, a hypoechoic lesion was detected and biopsied. Analysis of the biopsy specimen disclosed granulomatous prostatitis with caseous necrosis. The patient received antituberculous therapy which achieved clinically good results. CONCLUSIONS: Granulomatous prostatitis is a relatively common complication after intravesical BCG instillation (0.9% of treated patients) and its management includes discontinuation of the instillation and the administration of isoniazid and rifampin. US-guided needle biopsy is warranted to rule out adenocarcinoma of the prostate. BCG instillations are well tolerated in more than 95% of the patients and antituberculous therapy has been proven effective in the management of complications.