Open Journal of Urology, 2013, 3, 269-271
Published Online November 2013 (
Open Access OJU
Tuberculosis of the Prostate Gland Masquerading
Prostate Cancer: A Case Report
Sani Ali Aji1*, Sani Usman Alhassan1, Sharfuddeen Abbas Mashi1, Muhammad Ibrahim Imam2
1Urology Unit, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
2Department of Pathology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
Email: *
Received September 25, 2013; revised October 21, 2013; accepted October 28, 2013
Copyright © 2013 Sani Ali Aji et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Tuberculosis is one of the most important infectious diseases, particularly in developing countries. Involvement of the
prostate gland is very rare. We present a 70-year-old man who presented with low back pain and progressive weakness
of the lower limbs associated with irritative lower urinary tract symptoms. Prostate glan d was enlarged, hard and nodu -
lar. Prostate specific antigen was 6 ng/ml, Erythrocytes sedimentation rate was 130 mm/hr and Monteux was positive.
Prostate biopsy revealed features of tuberculosis and lumbosacral radiograph revealed features of Pott’s disease. Diag-
nosis of disseminated tuberculosis with prostate involvement was made and patient was placed on anti-tuberculosis
drugs with good response.
Keywords: Disseminated Tuberculosis; Prostate Gland; Diagnosis
1. Introduction
Tuberculosis is one of the most important infectious dis-
ease, particularly in developing countries like Nigeria.
Approximately one third of the world population is in-
fected with tuberculosis [1]. It has been estimated that
the genus “mycobacteria” causes more suffering for the
humans than all the other bacterial genera combined [2].
Pulmonary tuberculosis is the most common form of
the disease and comprises of 68.4% of all cases, 20% to
25% of cases are extrapulmonary, while only 27% of the
extrapulmonary tuberculosis involves the genitourinary
system [3]. Tuberclosis of the prostate gland is seen in
only 2.6% of genitourinary tuberculosis [1].
Tuberculosis involving the prostate gland, apart from
being rare, can also mimic cancer of the prostate as well
as BPH and therefore requires a high index of suspicion.
Here we present a case of disseminated tuberculosis
involving the spine and the prostate gland, thereby mas-
querading as prostate cancer.
2. Case Report
A 70-year-old man was referred to our clinic with a
working diagnosis of prostate carcinoma from General
outpatient department of our hospital.
He presented with low back pain for 11 months and
inability to walk for 1 month. He had associated irritative
lower urinary tract symptoms but no obstructive symp-
toms. No history of haematuria. No history of trauma.
No history of fever, cough, contact with a person with
chronic cough or excessive night sweats, however he had
anorexia and progre ssi ve weight loss.
On examination, he was found to be an elderly man on
a wheelchair, he was not pale, afebrile, not dehydrated,
no significant peripheral lymphadenopathy and no pedal
oedema. Chest, cardiovascular and abdominal examina-
tions were essentially normal, however on rectal exami-
nation; the prostate was enlarged, hard and nodular. Power
on both lower limbs was 3/5. There was no sensory im-
pairment. Examination of the spines did not reveal any
His serum urea, electrolytes and creatinine were within
normal limits. Prostate specific antigen was 6 ng/ml.
Erythrocytes sedimentation rate was 130 mm/hr and Man -
teux test was positive. Prostatic biopsy revealed poorly
preserved prostatic tissue with few acini, the abundant
fibromascular stroma shows predominantly caseous ne-
crosis, occational “horse-shoe” shaped multinucleated g ia nt
cells and lymphocytic infiltrates (Figures 1 and 2). Lumbo-
sacral radiographs reveal reduction of space—L1/L2,
*Corresponding author.
Figure 1. Show ing caseous necrosis, occational “horse-shoe”
shaped multinucleated giant cells and lymphocytic infil-
trates (40× magnification).
Figure 2. At lower magnification showing the same (10×
L3/L4; with osteolytic changes, reduction in height of L5
and wide spr ead osteophytes (Figures 3 and 4). Chest x-
ray was normal.
Based on the above findings, diagnosis of Dissemi-
nated Tuberculosis was made; patient was also reviewed
by Orthopedic Surgeon and was then commenced on
anti-tuberculosis drugs with good response.
3. Discussion
Tuberculosis (TB) remains a major public health problem
in developing countries [4]. It can involve any organ sys-
tem, however when it involves two or more organ system,
it is referred to as Disseminated Tuberculosis (DTB) [2].
Involvement of the prostate gland is very rare, but can
occur either in isolation, [5] with other Genitourinary
organs like epididymis and seminal vesicle, or as part of
a DTB [2].
TB involving the prostate may be very difficult to dif-
ferentiate from the carcinoma of the prostate, particularly
Figure 3. Showing reduction of space—T12/L1 with oste-
olytic changes.
Figure 4. Showing reduction in height of L5 and wide
spread osteophytes.
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when prostate is hard and nodular on digital rectal ex-
amination [6]. Prostate TB is mainly diagnosed inciden-
tally, either following trucut needle biopsy of the prostate
for a suspected carcinoma of the prostate, [7] or after
prostatectomy specimen for Benign Prostatic Hyperplasia
is subjected to histology [8]. Very rarely prostate cancer
can co-exist with TB of the Prostate [9].
In this case report, the patient was initially seen by a
Family Physician, who made a diagnosis of metastatic
carcinoma of the Prostate based on the Paraparesis, and
the findings of a hard nodular prostate on rectal examina-
K. Huang et al. in Taiwan, conducted a study on 10
patients over a period of 10 years, who all presented with
digital rectal examination findings suggestive of Prostate
cancer, but needle biopsy of the prostate revealed tuber-
culosis [6].
A. Kostakopoulos et al. also presented 5 cases of TB
of the prostate, all of which were incidental histologic
findings after Trans-urethral resecti on of the Prostate [10].
P. M. Karup et al. and M. A. Gafur et al. have all pre-
sented a patient with lower urinary tract symptoms and
prostate biopsy revealed granulomatous prostatitis [11,
We presented this case because it masqueraded as a
typical case of metastatic carcinoma of the prostate and
was only revealed after prostatic biopsy was done.
4. Conclusion
Tuberculosis of the prostate, though rare, can mimic p ros-
tate cancer as well as BPH. A high index of suspicion is
therefore needed in order to avoid misdiagnosis particu-
larly those practicing in the develop ing countries.
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