Review
IgG4-related prostatitis: expanding the spectrum of IgG4-related disease. A systematic review
C. Pamfil1, M.I. Mihon2, V. Surdu3, C. Bucșa4, G. Cabău5, L. Damian6, I. Felea7, T.N. Onea8, S. Rednic9, R. Talarico10
- Department of Rheumatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca; and Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
- Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
- Department of Anesthesia and Intensive Care II, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- Pharmacovigilance Research Center, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- Department of Medical Genetics Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca; and Department of Translational Immunology, Medfuture Institute for Biomedical Research, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. georgiana.cabau@gmail.com
- Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
- Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
- Faculty of Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
- Department of Rheumatology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca; and Department of Rheumatology, Emergency Clinical County Hospital, Cluj-Napoca, Romania.
- Department of Rheumatology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Italy.
CER19417
Review
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PMID: 41562347 [PubMed]
Received: 16/10/2025
Accepted : 17/11/2025
In Press: 21/01/2026
Abstract
OBJECTIVES:
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory condition that may affect any organ. Prostatic involvement is uncommon and under-recognised. The presentation often mimics benign prostatic hyperplasia or prostate carcinoma, causing diagnostic uncertainty. This systematic review synthesises evidence on IgG4-related prostatitis, focusing on clinical manifestations, diagnostic approaches, treatment, and outcomes.
METHODS:
Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, and Ovid were searched from inception to 12 February 2025. Eligible studies included English-language case reports, case series, and observational studies describing prostatic involvement in IgG4-RD. Data on demographics, clinical and laboratory findings, management, and outcomes were extracted and analysed descriptively.
RESULTS:
Fifty studies reporting 66 cases were included. Median age was 64 years (range 20–82). Serum IgG4 concentrations were elevated in most (median 832 mg/dL, range 5–4,500), while prostate-specific antigen (PSA) levels varied widely (0.01–180 ng/mL). Multiorgan involvement occurred in 57.8%, isolated disease in 6.2%. Lower urinary tract symptoms were most frequent (39.6%). Glucocorticoids, mainly prednisone, were the main therapy (69.2%), followed by surgery, chiefly transurethral resection of the prostate. Complete and partial responses occurred in 50.9% and 43.4%. Treatment type correlated with outcome (χ²=49.70; p<0.001). Malignancy (18.5%) was associated with higher mortality (p=0.028).
CONCLUSIONS:
IgG4-related prostatitis is a rare and likely under-recognised manifestation of IgG4-RD. Its overlap with benign and malignant prostatic disorders delays diagnosis. Serum IgG4 and PSA are unreliable markers of disease and monitoring. Glucocorticoids remain first-line therapy, with surgery in obstructive cases. Multicentre studies are needed to define prevalence, natural history, and optimal management.
