Abstract
BackgroundProstate schistosomiasis is a chronic inflammatory condition of the prostate. In an endemic environment, it may mimic the sinister condition of the prostate in its clinical presentation. Despite the high prevalence of urinary schistosomiasis documented in our environment, prostate involvement is rarely encountered in routine clinical practice. We report and share our experience in the management of two cases of prostate schistosomiasis that presented with abnormal digital rectal examination and elevated prostate-specific antigen suggestive of prostate cancer but proved otherwise by the histology report.Case presentationThe first patient was a 50-year-old man who presented with a history of voiding and storage lower urinary tract symptoms (LUTS) and urinary retention relieved by urethral catheterization. There was no other significant history except for past childhood terminal hematuria. The remarkable findings on physical examination were in the digital rectal examination which revealed enlarged prostate, hard, nodular, obliterated median groove, and restricted mobility of overlying rectal mucosa. The total serum prostate-specific antigen (PSA) was 1.2 ng/ml. Transrectal ultrasound-guided prostate biopsy and histology confirmed prostate schistosomiasis on a background of nodular hyperplasia. The second patient was an 80-year-old man who presented with a history of voiding and storage lower urinary tract symptoms (LUTS) and urinary retention relieved by urethral catheterization. There was no other significant history and no past childhood terminal hematuria. There were no remarkable findings on physical examination except for the enlarged prostate with benign findings on digital rectal examination. The initial total serum prostate-specific antigen (PSA) was 31.0 ng/ml. The repeated PSA was 7.5 ng/ml after antimicrobial therapy. Transrectal ultrasound-guided prostate biopsy and histology confirmed prostate schistosomiasis on a background of nodular hyperplasia. He had two sessions of Bipolar Transurethral Resection of the Prostate following failed medical treatment.ConclusionsSchistosomiasis of the prostate may mimic the clinical or biochemical presentation of prostate cancer. The attending physician requires high index of suspicion to arrive at this diagnosis, especially for the urologist practicing in an endemic area.
Highlights
Prostate schistosomiasis is a chronic inflammatory condition of the prostate
These create the wrong impression of sinister conditions of the prostate such as prostate cancer at presentation. These clinicopathological and biochemical alterations caused by the prostate schistosomiasis, as well as prevalent lower urinary tract symptoms (LUTS), due to benign prostate enlargement (BPE) seen in middle-aged men can present as diagnostic and therapeutic challenges to the attending urologist who manages these patients
The symptoms progressively worsened despite the use of medical therapy for benign prostate enlargement (BPE) culminating in acute urinary retention relieved by urethral catheterization
Summary
Prostate involvement may present a diagnostic dilemma due to its varied clinical features and biochemical changes. It may mimic the clinical presentation of the dreadful disease of the prostate. Despite endemicity of schistosomiasis in our environment, prostate schistosomiasis may probably be rare or its diagnosis is often not suspected or missed during patient’s evaluation for LUTS. Its coexistence with benign prostatic hyperplasia may compound the manifestation of LUTS in these patients leading to challenges in management. A high index of suspicion as well as clinical and histopathological findings is required to arrive at this diagnosis, especially for the urologist practicing in an endemic area
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