DIAGNOSIS OF NONSPECIFIC GRANULOMATOUS PROSTATITIS IN PATIENTS UNDERGOING PROSTATE BIOPSY UNDER TRANSRECTAL ULTRASOUND GUIDANCE

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1 32, 4, 2010, 3.,.. DIAGNOSIS OF NONSPECIFIC GRANULOMATOUS PROSTATITIS IN PATIENTS UNDERGOING PROSTATE BIOPSY UNDER TRANSRECTAL ULTRASOUND GUIDANCE N. Smilov, N. Koleva and I. Lozev Medical Institute Ministry of Interior : - ( ), ( - ) - ( ) 12 ( ). 486.,. 12 (2,5%). 2,8 18,4 ng/ml. 3-, 9 - / ,, -., -. :,,, - : -.,,. 79, 1606,.: , smilov_nencho@yahoo.com Summary: The aim of the current study is to evaluate retrospectively the data from digital rectal examination (DRE) and transrectal ultrasound (TRUS) examination and the PSA levels in 12 patients with nonspecific granulomatous prostatitis (NSGP) diagnosed histologically. The results of 486 patients from prostate iopsy under TRUS guidance were studied. All patients underwent DRE, transrectal core iopsy of the prostate under TRUS guidance and PSA test. Nonspecific granulomatous prostatitis was found in 12 patients (2,5%). The level of the serum PSA varied from 2,8 to 18,4 ng/ml. The digital rectal examination found 3 patients with local asymmetrical and dense prostate and 9 patients with prostate nodule/s. In 3 patients, the TRUS findings were normal while single or multiple nodules were found in 9 patients. Currently, there is no clinical, iochemical or imaging method capale of diagnosing with sufficient proaility the condition of NSGP. This diagnosis can e defined with certainty with histological test after transrectal core iopsy of the prostate. It is necessary these patients to e followed up in order not to omit the presence or the eventual development of prostate cancer. Key words: nonspecific granulomatous prostatitis, prostate iopsy, transrectal ultrasound, prostate cancer Address for correspondence: N. Smilov, MD, Medical Institute Ministry of Interior, 79 Skoelev lvd., Bg-1606 Sofia, tel.: , smilov_nencho@yahoo.com. -., - -.., -. - ( ), - ( )

2 , 4, 2010, 3 ( ) 12 - ( ) , -.,, (2,5%). - 64,8. (53-75). 2,8 18,4 ng/ml. 3- ( - ) 9 (4 ) (5 ) - - (7 ) (2- - ) / (. 1. 1). -, a. 1.. a / / () 3 ( ) 48 (31-67 ) 2,8 18,4 ng/ml < 0,15 ng/ml/cc 4 > 0,15 ng/ml/cc ,6-13,2 ng/ml % 11-24% 3- -, 9 /.,.,, -,, (. 2).

3 , 4, 2010, , % a c. 2.. a.... c. o. ( ) Tanner Mc Donald [22]. 30% ( ),, - [8, 21] (. 2) [19] 60-70% 3-5% Mycoacterium avium BCG : 20-25% 1-3%., (,,,, ) -,, - [18, 23]. -., [14]. [3], - [14] % [21]. 0,44% - - 0,77% -, [23]. Makom. -, ( ) 71,5%, 2% 26,5% [13]. Osca Garcia. 5,5-21

4 , 4, 2010, 3 4 (19%) [9, 23]. 2,5% [19, 20] (0,5-144 ng/ml) - [1, 17].,, -. - ( ), -. - /, ( - ) [2, 6, 7].,, - [4, 16, 20]. - (. 3), [12, 13]. a. 3. a.... -,,. [18]. - -,. - -, -. ( ). [18, 23] , [18]. - [10, 11, 15]. -, CD68 (. 4).. ( ) [12]. -., - - [5].

5 , 4, 2010, a. ( - ) ( ).., CD68,, ,, -. 1.,..., 47, 2008, 4. 2.,.., 2, 1994, 4, A l e x a n d e r, R. B. et al. Granulomatous prostatitis linked to HLA-DRB1. J. Urol., 171, 2004, C a r i o u, G. et al. Correlations etween radiography, ultrasonography, computed tomography and pathologic findings in prostatic disease. Urology, 26, 1985, 6, C l e m e n t s, R. et al. Transrectal ultrasound appearance of granulomatous prostatitis. Clin. Radiol., 47, 1993, D a h a m i, Z. et al. Granulomatous prostatitis (report of 6 cases). Ann. Urol. (Paris), 37, 2003, 5, D e S o u z a, N. M. et al. Diffusion-weighted magnetic resonance imaging: a potential non-invasive marker of tumour aggressiveness in localized prostate cancer. Clin. Radiol., 63, 2008, 7, E p s t e i n, J. I. et G. J. Netto, eds. Biopsy Interpretation of the Prostate. 4th ed. Philadelphia, Lippincott Williams & Wilkins, H e n d e r s o n, C. G. et al. Rapidly progressing adenocarcinoma of the prostate presenting as prostatitis. J. Urol., 168, 2002, 2, K o r r o v i t s, P. et al. Prevalence of asymptomatic inflammatory (National Institutes of Health Category IV) prostatitis in young men according to semen analysis. Urology, 71, 2008, 6, L a F o n t a i n e, P. D. et al. Incidence of granulomatous prostatitis and acid-fast acilli after intra vesical BCG therapy. Urology, 49, 1997, 3, M a t s u m o t o, T. et al. Nonspecific granulomaotus prostatitis. Urology, 39, 1992, M a k o m, A., N. Reverdin et J. N. Cox. Prostatites granulomatoses non specific. Schweiz. Med. Wschr., 115, 1985, M o h a n, H. et al. Granulomatous prostatitis an infrequent diagnosis. Int. J. Urol., 12, 2005, N a m i m o t o, T. et al. The value of dynamic MR imaging for hypointensity lesions of the peripheral zone of the prostate. Comput. Med. Imaging Graph., 22, 1998, 3, N e y, C., H. L. Miller et J. L. Levy. Granulomatous prostatitis. Special reference to radiologic findings. Urology, 21, 1983, 3, O p p e n h e i m e r, J. R., H. Kahane et J. L. Epstein. Granulomatous prostatitis on needle iopsy. Arch. Pathol. La. Med., 121, 1997, R o s a i, J. Ackerman s Surgical Pathology. 8 ed. St. Louis, Mosy, S o h a i l, M. R., P. E. Andrews et J. E. Blair. Coccidioidomycosis of the male genital tract. J. Urol., 173, 2005, 6, S p e r a n d e o, G. et al. Transrectal ultrasonography for the early diagnosis of adenocarcinoma of the prostate: a new maneuver designed to improve the differentiation of malignant and enign lesions. J. Urol., 169, 2003, 2, S t i l l w e l l, T. J., D. E. Engen et G. M. Farrow. The clinical spectrum of granulomatous prostatitis: a report of 200 cases. J. Urol., 138, 1987, T a n n e r, F. H. et J. R. Me Donald. Granulomatous prostatitis. A histologic study of a group of granulomatous lesions collected from prostate glands. Arch. Pathol., 36, 1943, Val-B e r n a l, J. F. et al. Nonspecific (idiopathic) granulomatous prostatitis associated with low-grade prostatic adenocarcinoma. Ann. Diagn. Pathol., 8, 2004, 4,