IgG4-related prostatitis

Lore & Background

Several case studies on IgG4-related prostatitis have been reported. Patients commonly present with lower urinary tract symptoms such as dysuria, pollakisuria, urinary urgency, and a feeling of incomplete emptying. The clinical presentation is similar to benign prostatic hyperplasia or chronic prostatitis, although pain does not usually appear to be significant. Diagnosis can be made from histological examination if prostate biopsy or surgery has been performed, with hallmark features including storiform fibrosis, dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, and obliterative phlebitis. However, identification depends on awareness of the condition, as special immunostaining is required.

Reader's Guide

IgG4-related prostatitis is significant as a manifestation of IgG4-related disease, an emerging entity that can mimic common prostatic conditions like benign prostatic hyperplasia or chronic prostatitis. Its recognition is important because it responds well to glucocorticoid therapy, provided advanced fibrotic lesions have not caused irreversible damage. Men given glucocorticoids for IgG4-RD at other sites sometimes report relief of lower urinary tract symptoms, suggesting underdiagnosis. However, cases are likely to be misdiagnosed as benign prostatic hyperplasia and treated with alpha blockers, whose efficacy in this condition remains unclear. FDG-PET scans have been reported useful for detection. The condition highlights the need for awareness among urologists and pathologists to ensure proper diagnosis and treatment.

Did You Know?

• Men with IgG4-related prostatitis may have elevated blood levels of IgG4, IgE, and eosinophils.
• FDG-PET scans have been reported as useful for detecting IgG4-related prostatitis in men with IgG4-RD.
• The efficacy of alpha blockers in IgG4-related prostatitis remains unclear.