Nowadays, the most efficient form of intravesical
immunotherapy for superficial
transitional cell carcinoma of the urinary bladder is the instillation of bacillus Calmette-Guérin (BCG), proceeding from an attenuated strain of Mycobacterium bovis. In up to 40% of cases, its instillation is associated with significantly elevated
prostate-specific antigen (PSA) levels. In these cases, prostate biopsy should be withheld for 3 months and PSA should be monitored. Bacillary
prostatitis is a rare occurrence in patients treated with intravesical BCG
immunotherapy. Although symptomatic bacillary
prostatitis is even rarer, it is the worst type of this condition. The aims of this study are to report a case of bacillary
prostatitis as a rare adverse effect of intravesical BCG
immunotherapy and to make a theoretical review about how to manage this complication. A 58-year-old man, former smoker, underwent a transurethral resection of the bladder in February 2004 because of a papillary
transitional cell carcinoma of the bladder (pT1G2N0M0). After surgery, BCG instillation
therapy was given in a total of 15 instillations, the last one in March 2007. In the last 3 months of
therapy, until May 2007, a progressive increase in his PSA level was registered, and he underwent a prostate biopsy revealing granulomatous
prostatitis of bacillary etiology. The semen culture was positive for M. bovis. After 3 months of a two-
drug (
isoniazid and
rifampin) antituberculous regimen, the semen culture became negative and the PSA level decreased. The early identification of intravesical BCG
immunotherapy complications allows their effective treatment. However, when a histological diagnosis of asymptomatic granulomatous
prostatitis is made, the execution and type of treatment are controversial.