Okusa Hiroshi, Irie Akira, Chin Ikyou, Baba Shiro, Mitomi Hiroyuki, Shitara Toshiya
Department of Urology, Kitasato University School of Medicine.
Hinyokika Kiyo. 2003 Sep;49(9):555-7.
Intravesical instillation of bacillus Calmette-Guerin (BCG) is the first-line therapeutic option for flat carcinoma in situ (CIS) of the bladder. Intravesical BCG instillation has been demonstrated to cause granulomatous prostatitis. Bladder CIS often also is known to show prostatic stromal invasion. We report a case of BCG-induced granulomatous prostatitis and a case of prostatic stromal invasion of bladder CIS accompanied by locally advanced prostate cancer, which showed similar clinical findings after the intravesical BCG therapy. In these 2 patients, urinary symptoms such as dysuria were prolonged regardless of anti-tuberculous medication, hard nodules were palpable at the prostate, and hypoechoic lesions were visualized by transrectal ultrasound. Both patients were treated by transurethral resection of the prostate, and the diagnoses were made by histopathological examination. Urinary symptoms were resolved in both patients after surgery, but the prostatic stromal tumor showed recurrence of growth. We report the usefulness of transurethral resection of the prostate for medication-resistant BCG-induced granulomatous prostatitis, and the importance of the correct diagnosis of prostatic stromal invasion of bladder CIS especially in the cases with concurrent prostate cancer.
膀胱内灌注卡介苗（BCG）是膀胱扁平原位癌（CIS）的一线治疗选择。膀胱内灌注BCG已被证明可引起肉芽肿性前列腺炎。膀胱CIS通常也已知会出现前列腺基质浸润。我们报告一例BCG诱导的肉芽肿性前列腺炎病例和一例膀胱CIS伴局部晚期前列腺癌的前列腺基质浸润病例，这两例在膀胱内BCG治疗后表现出相似的临床症状。在这2例患者中，无论使用抗结核药物，排尿困难等泌尿系统症状都会持续很长时间，前列腺可触及硬结节，经直肠超声可见低回声病变。两名患者均接受了经尿道前列腺切除术，并通过组织病理学检查做出诊断。术后两名患者的泌尿系统症状均得到缓解，但前列腺基质肿瘤出现复发生长。我们报告经尿道前列腺切除术对耐药性BCG诱导的肉芽肿性前列腺炎的有效性，以及正确诊断膀胱CIS前列腺基质浸润的重要性，特别是在并发前列腺癌的病例中。
