Tuberculosis of the prostate with benign prostatic hyperplasia with prostatitis a？？ A rare presentation

Genitourinary tuberculosis contributes to 10-14% of extrapulmonary tuberculosis and is a major health problem in India. Prostate tuberculosis is uncommon and is usually found incidentally following transurethral resection. The most common mode of involvement is haematogenous, though descending infection and direct intracanalicular extension is known. Predisposing factors include prior tubercular infection, immunocompromised status, previous BCG therapy. Apart from histopathological examination which is confirmatory to diagnosis, urine PCR with good sensitivity and specificity, may be quite helpful in the diagnosis. Imaging techniques like CT/MRI also allow good visualization of the lesion and its extension. We report a case of a 35 year old male who presented with complaints of difficulty in micturition. On digital rectal examination prostate was found to be enlarged with nodularity. TRUS biopsy showed diffuse caseating epithelioid granulomas. Treatment was given in the form of chemotherapy regimen of 4 anti-tubercular drugs. This case has emphasised the importance of considering prostatic tuberculosis in the differential diagnosis of carcinoma prostate, both of which may have the same clinical presentation. With a high index of suspicion, it may be possible to diagnose a larger number of cases of prostatic tuberculosis, especially in our country where tuberculosis is almost endemic