Xanthogranulomatous prostatitis (XGP) is a rare and poorly understood inflammatory condition of the prostate that often mimics prostate adenocarcinoma both clinically and radiographically. Its presentation, including elevated prostate-specific antigen (PSA) levels, abnormal digital rectal examinations, and suspicious findings on multi-parametric MRI prostate, can be nearly indistinguishable from that of prostate cancer. This overlap presents a significant diagnostic challenge for clinicians, with the potential for misdiagnosis leading to unnecessary and invasive treatments such as radical prostatectomy or radiation therapy, which carry considerable morbidity.

This case report highlights the importance of distinguishing XGP from invasive prostate cancer. It underscores the need for a multidisciplinary approach, involving urologists, radiologists, pathologists, and infectious disease specialists, to ensure accurate diagnosis and prevent overtreatment. By sharing this rare case of XGP, we aim to increase awareness of this condition, emphasize the importance of considering it in the differential diagnosis of suspected prostate malignancy, and provide insights into its management to improve patient outcomes.

XGP prostate has the ability to mimic prostate adenocarcinoma both clinically and radiographically. The management of XGP includes treatment with high dose antibiotics and an alpha-blocker. In certain cases, when patients demonstrate obstructive symptoms with poor flow on uroflowmetry or ultrasound evidence of poor emptying and fail to improve with antibiotic therapy, a transurethral resection of the prostate may be necessary to optimize urinary flow to aid in clearance of the infection.

Xanthogranulomatous prostatitis is a rare but important condition that can mimic prostate carcinoma and can show avidity on PET-PSMA which can lead to a misdiagnosis of prostate adenocarcinoma. It is vital for clinicians to follow a standardized diagnostic algorithm when encountering patients with atypical presentations, an elevated PSA level and/or suspicious MRI or PSMA-PET/CT findings. This is to prevent recommendation of unnecessary radical treatment to the patient. Management includes treatment with high dose antibiotics, alpha-blockers and transurethral resection of prostate.