• AI
  • Molecular Imaging
  • CT
  • X-Ray
  • Ultrasound
  • MRI
  • Facility Management
  • Mammography

Granulomatous Prostatitis

Article

Clinical History: In September 2011, a 76-year-old male presented for a routine multiparametric MRI to follow a Gleason 6 cancer as part of his Active Surveillance program. This cancer was proven by biopsy the previous year. Initial prostate imaging confirmed low-grade, low risk disease (Figure A, Figure B, Figure C).

[[{"type":"media","view_mode":"media_crop","fid":"23623","attributes":{"alt":"","class":"media-image","id":"media_crop_5275405906777","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1913","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure A. T2-weighted axial image                                

[[{"type":"media","view_mode":"media_crop","fid":"23624","attributes":{"alt":"","class":"media-image","id":"media_crop_9300202341230","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1914","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure B. Parametric overlay

[[{"type":"media","view_mode":"media_crop","fid":"23625","attributes":{"alt":"","class":"media-image","id":"media_crop_1730313041808","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1915","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure C. Kinetic analysis

Imaging also revealed an incidental bladder polyp on the left  (Figure D, Figure E).  

[[{"type":"media","view_mode":"media_crop","fid":"23626","attributes":{"alt":"","class":"media-image","id":"media_crop_1663990110306","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1916","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure D. Coronal T2-weighted image of the polyp

[[{"type":"media","view_mode":"media_crop","fid":"23627","attributes":{"alt":"","class":"media-image","id":"media_crop_3179704321505","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1917","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure E. Axial T2-weighted image

The polyp was subsequently biopsied and proven to be bladder cancer for which he received treatment.

On routine digital rectal examination (DRE) follow up in May 2012, a nodular mass was appreciated in the left lobe of the prostate gland. Color Doppler showed increased blood flow and the patient’s PSA had increased.

Multiparametric MRI was performed and compared to the previous study in September 2011. Dramatic change was evident in the left peripheral zone (PZ) mid-gland to base with bulging of the capsule (Figure F, Figure G, Figure H) and positive spectroscopic findings.

[[{"type":"media","view_mode":"media_crop","fid":"23628","attributes":{"alt":"","class":"media-image","id":"media_crop_7015332931630","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1918","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure F. Axial T2-weighted image                                  

[[{"type":"media","view_mode":"media_crop","fid":"23629","attributes":{"alt":"","class":"media-image","id":"media_crop_9739144279837","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1919","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure G. Parametric overlay image

[[{"type":"media","view_mode":"media_crop","fid":"23630","attributes":{"alt":"","class":"media-image","id":"media_crop_8180557101830","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1920","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]

Figure H. Kinetic analysis

Diagnosis: Biopsy showed prostatitis.

Discussion: Notably, this patient was treated with intravesical bacillus Calmette-Guérin (BCG) immunotherapy for his bladder tumor. This caused BCG-induced granulomatous prostatitis, nicely demonstrated as change from baseline.

References
1. Aust TR, Massey JA. Tubercular prostatic abscess as a complication of intravesical bacillus Calmette–Guérin immunotherapy. International Journal of Urology. 2005;12:920–921.
2. Lafontaine PD, Middleman BR, Graham SD, et al. Incidence of granulomatous prostatitis and acid-fast bacilli after intravesical BCG therapy. Urology. 1997;49:363–366.

Robert Princenthal, MD, Rolling Oaks Radiology, Thousand Oaks, CA

Related Videos
Can Fiber Optic RealShape (FORS) Technology Provide a Viable Alternative to X-Rays for Aortic Procedures?
Does Initial CCTA Provide the Best Assessment of Stable Chest Pain?
Making the Case for Intravascular Ultrasound Use in Peripheral Vascular Interventions
Can Diffusion Microstructural Imaging Provide Insights into Long Covid Beyond Conventional MRI?
Assessing the Impact of Radiology Workforce Shortages in Rural Communities
Emerging MRI and PET Research Reveals Link Between Visceral Abdominal Fat and Early Signs of Alzheimer’s Disease
Reimbursement Challenges in Radiology: An Interview with Richard Heller, MD
Nina Kottler, MD, MS
The Executive Order on AI: Promising Development for Radiology or ‘HIPAA for AI’?
Related Content
© 2024 MJH Life Sciences

All rights reserved.