Tuberculosis of the Prostate: Four Cases and a Review of the Literature

Objectives: Tuberculosis of the prostate is a very rare disease. Most urologists are not familiar with it. Here, we wish to present our experience with 4 cases of this disease and a review of literature. Methods: This was a retrospective study in a tertiary care center from January 2001 to December 2009. results: All the patients were in their fourth or fifth decade of life. Irritative voiding (100%) followed by hemospermia (50%) were the common presenting symptoms. A history of pulmonary tuberculosis was absent in all cases. Three out of 4 cases (75%) had a suspicious prostate on the digital rectal examination. PSA assays were slightly elevated with a mean of 8.26 ng/ml. Urine analysis revealed sterile pyuria in all patients, and the urine culture was negative. The urine and seminal fluid positivity rate was 33.33% for the AFB test, 66.6% for the M. tuberculosis culture test, and 100% for PCR. The transrectal ultrasonogram showed hypoechoic areas with irregular outlines in 3 cases (75%) and calcification in 2 cases (50%). All patients were scheduled to receive 6 months of chemotherapy with isoniazid, rifampicin, and Ethambutol or pyrazinamide. conclusions: A high index of suspicion with a wide range of investigations may be required to achieve a complete diagnosis of prostatic tuberculosis. Although short-term multi-drug chemotherapy is an ideal mainstay of treatment, surgery has a definitive role in advanced disease.