Prostatic Tuberculosis Mimicking Clinically Significant Prostate Cancer in a Patient Presenting With Low Ejaculate Volume: A Case Report

Prostatic tuberculosis is a rare manifestation of genitourinary tuberculosis and may closely mimic clinically significant prostate cancer on multiparametric MRI, creating considerable diagnostic uncertainty. We report the case of a 46-year-old Nigerian man undergoing follow-up for latent tuberculosis infection who reported a progressive reduction in ejaculatory volume while attempting conception. He had minimal lower urinary tract symptoms (International Prostate Symptom Score: 1/35), a prostate-specific antigen level of 3.94 µg/L, and a palpable prostatic nodule on digital rectal examination. Multiparametric MRI demonstrated highly suspicious lesions involving both the peripheral and transition zones, together with pelvic lymphadenopathy, raising concern for clinically significant prostate cancer. Histopathological examination revealed extensive granulomatous inflammation with areas of necrosis, while Ziehl-Neelsen and fungal stains were negative. PCR testing performed on the biopsy tissue subsequently confirmed Mycobacterium tuberculosis complex, without evidence of isoniazid or rifampicin resistance. The patient completed anti-tuberculous therapy, with radiological resolution of the lesions and normalisation of prostate-specific antigen levels, although persistent ejaculatory dysfunction required specialist fertility assessment. This case highlights the ability of prostatic tuberculosis to fulfil radiological criteria typically associated with prostate malignancy despite minimal urinary symptoms. Recognition of this rare entity is important to avoid misdiagnosis, prevent inappropriate oncological management, and facilitate the timely initiation of anti-tuberculous treatment.