What does a final diagnosis of necrotizing granulomatous inflammation in the prostate with benign prostatic glandular and stromal hyperplasia and no malignancy identified mean?

Understanding Your Prostate Pathology Report

Your pathology report shows necrotizing granulomatous inflammation in your prostate tissue, which is a rare inflammatory condition (occurring in only 1.2% of prostate specimens) that requires identification of the underlying cause through special stains and potentially treatment depending on what is found. 1

What This Diagnosis Means

Your report contains three key findings:

• Necrotizing granulomatous inflammation: This describes a specific pattern of inflammation where immune cells (histiocytes and giant cells) form clusters (granulomas) with areas of tissue death (necrosis). 2, 3

• Benign prostatic hyperplasia: This is common age-related prostate enlargement with no concerning features. 1

• No malignancy: Importantly, no prostate cancer was identified in your specimen. 1

Why Special Stains Are Pending

The pathologist has ordered GMS (Gomori methenamine silver) and AFB (acid-fast bacilli) stains because necrotizing granulomatous prostatitis can have multiple causes that require different management approaches:

Infectious Causes (Must Be Ruled Out)

• Fungal infections: Coccidioides immitis (in endemic areas like Arizona) can cause prostatic granulomas, detected by GMS stain. 1

• Mycobacterial infections: Tuberculosis or atypical mycobacteria (like M. abscessus) can cause necrotizing granulomatous prostatitis, detected by AFB stain. 2

• Other fungi: Cryptococcus and other organisms may be identified. 3

Non-Infectious Causes

• BCG therapy: If you received intravesical BCG for bladder cancer, this can cause granulomatous prostatitis. 4

• Autoimmune/idiopathic: Most cases (when stains are negative) are classified as nonspecific granulomatous prostatitis. 5, 3

Clinical Implications Based on Your Procedure Type

If This Was Found on Needle Biopsy

• Observation is appropriate if special stains are negative and you have no symptoms of systemic infection (fever, weight loss, night sweats). 1

• Monitor for symptoms and follow up with your urologist. 1

If This Was Found After Prostatectomy

• Antifungal therapy should be initiated if Coccidioides or other fungi are identified, typically with oral fluconazole for 14 months. 1

• Antimycobacterial therapy is required if AFB stains are positive, as M. abscessus can cause prolonged wound healing complications, urethrorectal fistulas, and pelvic abscesses after surgery. 2

• Even with negative stains, closer monitoring is warranted due to the extensive tissue violation from surgery. 1

Critical Warning Signs

Watch for these symptoms that require immediate medical attention:

• Fever, chills, or night sweats (suggesting systemic infection). 1

• Poor wound healing or drainage from surgical sites (particularly concerning for mycobacterial infection). 2

• Worsening urinary symptoms or pelvic pain. 1

Next Steps

1. Wait for the addendum report with GMS and AFB stain results—this will determine if treatment is needed. 1

2. Inform your physician if you live in or have traveled to areas endemic for Coccidioides (Arizona, California, New Mexico, Texas). 1

3. Disclose any history of BCG therapy for bladder cancer or immunosuppressive conditions. 4

4. Follow up promptly once stain results are available to discuss whether antifungal or antimycobacterial therapy is indicated. 1, 2

The key message is that while granulomatous prostatitis can mimic cancer clinically, your biopsy confirmed no malignancy, but the specific cause must be identified through pending stains to determine if treatment is necessary. 1, 5