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Peer-reviewedCC BY 4.0World Journal of Urology

Intravesical BCG-induced granulomatous prostatitis mimicking prostate cancer in patients with non-muscle invasive bladder cancer: a systematic review

  • Keiichiro Miyajima1,2
  • Marcin Miszczyk1,3
  • Maximilian J. Rabil4
  • Felix Lübbersmeyer1,5
  • Kazuma Tsuboi1,6
  • Akihiro Matsukawa1,2
  • Fumihiko Urabe2
  • Keiichiro Mori1,2
  • Takafumi Yanagisawa1,2
  • Michael S. Leapman4
  • Takahiro Kimura2
  • Shahrokh F. Shariat1,7,8,9,10,11,12,13
13 affiliations
  1. 1Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
  2. 2Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
  3. 3Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland
  4. 4Department of Urology, Yale School of Medicine, New Haven, Connecticut USA
  5. 5Department of Urology, Medical University Center Hamburg-Eppendorf, Hamburg, Germany
  6. 6Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
  7. 7Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX USA
  8. 8Department of Urology, Weill Cornell Medical College, New York, NY USA
  9. 9Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
  10. 10College of Medical Health Technologies, Al-Turath University, Mansour, Baghdad Iraq
  11. 11Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
  12. 12Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
  13. 13Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, Vienna, 1090 Austria
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Abstract

Purpose: Bacillus Calmette–Guérin (BCG) therapy is a standard-of-care for non–muscle-invasive bladder cancer (NMIBC), and granulomatous prostatitis (GP) is a side effect often misdiagnosed as prostate cancer (PCa). We conducted a systematic review to clarify the clinical spectrum of BCG-induced GP.

Methods: MEDLINE, Embase, and Web of Science were searched in June 2026. We sought studies reporting GP associated with BCG therapy for NMIBC, including case reports and case series. Risk of bias was evaluated using ROBINS-I and JBI tools. Findings were synthesized narratively (CRD420261324758).

Results: Forty-seven studies were included, comprising 23 case reports, 19 case series, and 5 comparative studies. In case series, abnormal digital rectal examination findings were reported in 100/240 (42%) evaluable cases. PSA elevation (> 4 ng/mL) occurred in 104/194 (54%) patients but often declined spontaneously during follow-up. Suspicious MRI findings were common, with PI-RADS ≥ 4 lesions reported in 71/82 (87%) cases, whereas biopsy-confirmed PCa was detected only in 12/151 (7.9%) patients. However, Grade Group and definitions of clinically significant PCa (csPCa) were incompletely and inconsistently reported, precluding a reliable estimate of csPCa frequency. Limitations include the predominance of descriptive studies and potential selection bias.

Conclusion: BCG-induced GP frequently presents with transient PSA elevation and suspicious MRI findings that rarely indicate true PCa. In BCG-exposed patients with elevated PSA or PI-RADS ≥ 4 lesions, structured observation with careful follow-up should be considered before proceeding to immediate biopsy.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00345-026-06883-3.

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Cite

BibTeXRIS
BibTeX
@article{miyajima2026intravesical,
  title = {{Intravesical BCG-induced granulomatous prostatitis mimicking prostate cancer in patients with non-muscle invasive bladder cancer: a systematic review}},
  author = {Keiichiro Miyajima and Marcin Miszczyk and Maximilian J. Rabil and Felix Lübbersmeyer and Kazuma Tsuboi and Akihiro Matsukawa and Fumihiko Urabe and Keiichiro Mori and Takafumi Yanagisawa and Michael S. Leapman and Takahiro Kimura and Shahrokh F. Shariat},
  journal = {World Journal of Urology},
  year = {2026},
  month = nov,
  doi = {10.1007/s00345-026-06883-3},
  url = {https://doi.org/10.1007/s00345-026-06883-3},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Intravesical BCG-induced granulomatous prostatitis mimicking prostate cancer in patients with non-muscle invasive bladder cancer: a systematic review
AU  - Keiichiro Miyajima
AU  - Marcin Miszczyk
AU  - Maximilian J. Rabil
AU  - Felix Lübbersmeyer
AU  - Kazuma Tsuboi
AU  - Akihiro Matsukawa
AU  - Fumihiko Urabe
AU  - Keiichiro Mori
AU  - Takafumi Yanagisawa
AU  - Michael S. Leapman
AU  - Takahiro Kimura
AU  - Shahrokh F. Shariat
PY  - 2026
DA  - 2026/11/05
JO  - World Journal of Urology
DO  - 10.1007/s00345-026-06883-3
UR  - https://doi.org/10.1007/s00345-026-06883-3
AB  - Purpose: Bacillus Calmette–Guérin (BCG) therapy is a standard-of-care for non–muscle-invasive bladder cancer (NMIBC), and granulomatous prostatitis (GP) is a side effect often misdiagnosed as prostate cancer (PCa). We conducted a systematic review to clarify the clinical spectrum of BCG-induced GP.  Methods: MEDLINE, Embase, and Web of Science were searched in June 2026. We sought studies reporting GP associated with BCG therapy for NMIBC, including case reports and case series. Risk of bias was evaluated using ROBINS-I and JBI tools. Findings were synthesized narratively (CRD420261324758).  Results: Forty-seven studies were included, comprising 23 case reports, 19 case series, and 5 comparative studies. In case series, abnormal digital rectal examination findings were reported in 100/240 (42%) evaluable cases. PSA elevation (> 4 ng/mL) occurred in 104/194 (54%) patients but often declined spontaneously during follow-up. Suspicious MRI findings were common, with PI-RADS ≥ 4 lesions reported in 71/82 (87%) cases, whereas biopsy-confirmed PCa was detected only in 12/151 (7.9%) patients. However, Grade Group and definitions of clinically significant PCa (csPCa) were incompletely and inconsistently reported, precluding a reliable estimate of csPCa frequency. Limitations include the predominance of descriptive studies and potential selection bias.  Conclusion: BCG-induced GP frequently presents with transient PSA elevation and suspicious MRI findings that rarely indicate true PCa. In BCG-exposed patients with elevated PSA or PI-RADS ≥ 4 lesions, structured observation with careful follow-up should be considered before proceeding to immediate biopsy.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00345-026-06883-3.
SN  - 0724-4983
SN  - 1433-8726
ER  -