INCIDENCE OF GRANULOMATOUS PROSTATITIS AND ACID-FAST BACILLI AFTER INTRAVESICAL BCG THERAPY

Objectives. To determine the incidence of granulomatous prostatitis an d acid-fast bacilli (AFB) after intravesical bacillus Calmette-Guerin (BCG) therapy for superficial bladder transitional cell carcinoma (TCC ) or carcinoma in situ (CIS). Methods. One hundred nineteen men underw ent radical cystoprostatectomy for invasive bladder cancer from Januar y 1, 1980 through December 31, 1995. Twelve patients had received intr avesical BCG therapy before undergoing cystoprostatectomy. Nine men wh o did not receive intravesical BCG therapy before undergoing cystopros tatectomy served as controls. The surgical specimens were examined wit h a Ziehl-Neelsen stain for the presence of granulomatous prostatitis and for the presence of AFB. Results. Granulomatous prostatitis was id entified in 9 of 12 patients (75%) who had received intravesical BCG t herapy. AFB were identified in 7 of 9 patients (77%) with granulomatou s prostatitis. Conclusions. Pathologic evidence of granulomatous prost atitis with AFB is a common occurrence after intravesical BCC therapy and its incidence is far greater than the reported incidence of sympto matic granulomatous prostatitis. AFB discovered during the evaluation of either an increased level of prostate-specific antigen or prostate nodule in otherwise asymptomatic men may require no specific therapy. (C) 1997, Elsevier Science Inc.