# A rare coexistence: Isolated prostate tuberculosis and nodular prostatic hyperplasia: A case report

## TL;DR

This case report describes a rare instance of isolated prostate tuberculosis coexisting with nodular prostatic hyperplasia, highlighting the diagnostic challenges and successful treatment.

## Contribution

The novelty lies in documenting a rare coexistence of isolated prostate tuberculosis and nodular prostatic hyperplasia, emphasizing diagnostic and management insights.

## Key findings

- Isolated prostate tuberculosis can mimic prostate cancer and nodular prostatic hyperplasia in clinical and radiological presentations.
- Histopathological evaluation is crucial for definitive diagnosis in TB-endemic regions.
- Timely anti-TB therapy after surgical intervention resolved symptoms, underscoring the importance of early recognition.

## Abstract

Isolated prostate tuberculosis is exceedingly rare, accounting for only 2.6 % of genitourinary TB cases. This condition often presents with mildly elevated PSA levels and imaging findings that may resemble those of advanced prostate cancer. This case holds significant value due to the rarity of documented reports worldwide and diagnostic challenges. It provides an essential perspective for physicians, encouraging them to maintain a heightened index of suspicion for prostatic tuberculosis in patients presenting with vague lower urinary tract symptoms and features of anemia, particularly in endemic regions.

Our case is a 75-year-old male patient who presented with non-specific lower urinary tract symptoms and features of anemia. Histopathologic examination confirmed the diagnosis of primary tuberculosis with nodular prostatic hyperplasia. Following anti-Tb treatment he showed notable improvement.

The spread of infection to the prostate is primarily hematogenous. Prostatic tuberculosis is usually asymptomatic or subclinical in the early stage and nonspecific irritating micturition in the late stage. The mainstay of management for TB prostatitis is medical treatment using multiple anti-TB drug combinations. Surgical therapy can be considered if patients do not respond to medical therapy.

Isolated prostatic tuberculosis is a rare clinical entity in which it can mimic non-specific prostatitis and prostatic carcinoma by its similar clinical presentation and digital rectal examination finding. Definitive diagnosis must be made by histopathological and bacteriologic studies.

•Isolated prostatic tuberculosis can clinically and radiologically mimic both prostate cancer and nodular prostatic hyperplasia, posing a diagnostic challenge.•Histopathological evaluation revealing granulomatous inflammation with caseous necrosis is essential for definitive diagnosis in resource-limited, TB-endemic settings.•Timely anti-TB therapy following surgical intervention led to full symptom resolution, highlighting the importance of early recognition and combined management.

Isolated prostatic tuberculosis can clinically and radiologically mimic both prostate cancer and nodular prostatic hyperplasia, posing a diagnostic challenge.

Histopathological evaluation revealing granulomatous inflammation with caseous necrosis is essential for definitive diagnosis in resource-limited, TB-endemic settings.

Timely anti-TB therapy following surgical intervention led to full symptom resolution, highlighting the importance of early recognition and combined management.