Case Report: Xanthogranulomatous prostatitis, a difficult differential diagnosis of prostate adenocarcinoma

Background: Xanthogranulomatous prostatitis is a rare benign inflammatory process of the prostate. Clinical, biochemical and imaging similarities make xanthogranulomatous prostatitis a difficult differential diagnosis of prostatic adenocarcinoma. Case presentation: We report the case of a 62 year-old diabetic patient, with 3 months of lower urinary tract symptoms. On digital rectal examination, the prostate was hard and nodular. Initial prostate-specific antigen (PSA) was 43.97 ng/mL, with urine analysis and transabdominal ultrasonography not showing any alterations. A multiparametric magnetic resonance imaging (mpMRI) of the prostate was performed and showed two foci that were classified as PI-RADS 4 lesions. A transrectal ultrasound guided prostate biopsy was then realized. After an initial suspicion of prostatic adenocarcinoma, on clinical, biochemical and radiological grounds, histopathological examination revealed a suppurated xanthogranulomatous prostatitis, with no evidence of malignancy. Conclusions: Xanthogranulomatous prostatitis is an uncommon benign inflammatory condition of the prostate that can clinically, biochemically and even radiologically simulate prostatic adenocarcinoma. We advise that if an older male with low urinary tract symptoms and a hard nodular prostate on digital rectal examination presents, the first diagnosis that one should think of is prostate adenocarcinoma, especially if PSA is high. However, only histopathological examination can differentiate with certitude between these two pathologies and is therefore essential for the diagnosis of xanthogranulomatous prostatitis.