Editorial Comment to Granulomatous prostatitis with high suspicion of prostatic adenocarcinoma on radiological imaging.

The current case report by Ambe et al. describes a patient with granulomatous prostatitis (GP) that mimics the imaging characteristics of prostate adenocarcinoma. Prostate adenocarcinoma is at the top of our differential diagnosis if there is an elevated serum prostate‐specific antigen (PSA) level, an abnormal prostate on digital rectal examination, and findings suspicious for prostate adenocarcinoma on multiparametric magnetic resonance imaging (mpMRI). However, clinicians should also consider the possibility of GP, as it can be difficult to differentiate between the two conditions.

We read the report with great interest because we know that GP is possible in patients who are suspected of having prostate adenocarcinoma based on their Prostate Imaging Reporting and Data System (PI‐RADS) score. One study found that of 105 patients with a PI‐RADS score of 5 who underwent mpMRI with transrectal ultrasound fusion‐targeted biopsy, 16 patients (15.5%) did not have cancer. It is important to take into account that 6 of these 16 patients (37.5%) had specific or nonspecific GP. The patients received targeted antibiotic therapy and had decreased PSA levels and downgraded PI‐RADS scores at repeat mpMRI evaluation, 6 months after their initial prostate biopsy. If the diagnosis of GP is suspected in patients with high PI‐RADS scores, a follow‐up scan using mpMRI after completion of antibiotic therapy can be considered.

Proper management of patients with GP is important. Asymptomatic patients with nonspecific GP can be either observed or treated with antibiotics or corticosteroids. Urinary tract infection with some bacteria, for example, Escherichia coli, can result in ocurrence of GP. Patients with GP who have a urinary tract infection should be given antibiotics either empirically or based on the results of urine culture.

Conflict of interest

The authors declare no conflict of interest.