Xanthogranulomatous prostatitis: benign prostate infection masquerading as invasive prostate cancer on MRI and PET-PSMA

Xanthogranulomatous prostatitis (XGP) is a rare inflammatory condition that can closely mimic prostate adenocarcinoma both clinically and radiologically. We report the case of a man in his mid-60s who presented with pelvic discomfort, dysuria, reduced urine flow and fever. He had an elevated prostate-specific antigen (PSA) level of 17.5 ng/mL and abnormal findings on digital rectal examination. Multi-parametric MRI of the prostate revealed a prostate lesion suspicious for malignancy invading the rectal wall and right obturator internus muscle. However, transperineal prostate biopsies confirmed XGP with no evidence of cancer. The patient was treated with a 4-month course of ciprofloxacin, which resolved most of his symptoms, and alpha-blocker therapy was commenced to improve urine flow. This case emphasises the diagnostic challenges posed by XGP, which can mimic T4 prostate cancer and potentially lead to overtreatment. Awareness of this condition, along with systematic diagnostic strategies, is essential to avoid unnecessary interventions and optimise patient management.