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Medical condition From Wikipedia, the free encyclopedia
IgG4-related prostatitis is prostate involvement in men with IgG4-related disease (IgG4-RD), which is an emerging fibroinflammatory disease entity which is characterised (i) by a tendency to mass forming lesions in multiple sites of the body and (ii) by usually a prompt response to steroid therapy.[1][2]
| IgG4-related prostatitis | |
|---|---|
| |
| Low power view of IgG4-related prostatitis. The prostatic stroma shows a dense inflammatory infiltrate and fibrosis (H&E, 100x) | |
| Specialty | Urology/Immunology |
Men with IgG4-related prostatitis may also present with manifestations of IgG4-RD at other sites anywhere in the body; involvement of different areas of the body can occur either at the same time (synchronously) or at different periods of time (metachronously).[3]
Several case studies on IgG4-related prostatitis have been reported. Patients have been noted to commonly present with lower urinary tract symptoms such as dysuria, pollakisuria, urinary urgency, and a feeling of incomplete emptying.[4][5] The clinical presentation is similar to that in benign prostatic hyperplasia or chronic prostatitis, although pain, as occurs in CP/CPPS, does not usually appear to be significant.[citation needed]
The diagnosis of IgG4-related prostatitis could be made from histological examination if prostate biopsy or surgery has been performed.[6] The hallmark histopathological features of established IgG4-related disease are storiform fibrosis, a dense lymphoplasmacytic (lymphocytes and plasma cells) infiltrate rich in IgG4-positive plasma cells, and obliterative phlebitis.[7]
However, identification depends on whether or not urologists and pathologists are aware of IgG4-related prostatitis/disease, as special immunostaining is required to identify the characteristic IgG4-positive plasma cells infiltration in prostatic tissue.[3]
Men with IgG4-related prostatitis may have similar findings to those that are frequently, but not always, seen in other organ manifestations of IgG4-related disease, such as elevated blood levels of IgG4, IgE and eosinophils.[citation needed]
FDG-PET scans have been reported to be useful as a diagnostic modality for detecting IgG4-related prostatitis in men with IgG4-RD.[6][8]
IgG4-related disease responds well, and often dramatically, to glucocorticoid therapy, provided that advanced fibrotic lesions have not resulted in irreversible damage, and this has included resolution of radiologic findings.[1] Men given glucocorticoids to treat IgG4-related disease at other anatomical sites sometimes report relief of their lower urinary tract symptoms, suggesting that IgG4-related prostatitis may be underdiagnosed.[6]
Cases are however likely to get misdiagnosed as benign prostatic hyperplasia and to get treated alternatively with medications such as alpha blockers. The efficacy of alpha blockers in IgG4-related prostatitis remains unclear.[3]
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