Xanthogranulomatous prostatitis is a rare type of granulomatous prostatitis, with very few cases described. We report the clinical, radiological and pathological findings of 5 cases of xanthogranulomatous prostatitis. All patients came for recurrent episodes of hematospermia (associated with fever in 3 patients). All patients suffered from lower urinary tract symptoms and an increased prostate- specific antigen (PSA) level associated with a suspicious digital rectal examination (DRE); however, at biopsy, the results were negative for xanthogranulomatous prostatitis. Due to persistent severe bladder outlet obstruction, after unsuccessful medical treatments, all patients underwent transurethral resection of prostate (TURP). Final histological examination revealed a xanthogranulomatous prostatitis. The xanthogranulomatous prostatitis can be an incidental finding after TURP and it can simulate prostatic malignancy with PSA elevation.