Differential Diagnosis
The patient's laboratory results show an elevated PSA (7.0), a slightly elevated white blood cell count (WBC) at 12.6, and elevated absolute neutrophil and lymphocyte counts. The rest of the blood cell indices are within normal limits. Based on these findings, the differential diagnosis can be categorized as follows:
Single Most Likely Diagnosis
- Prostatitis or Prostate Cancer: The elevated PSA level is a significant indicator for prostate issues, and given the patient's age (not specified but implied to be an adult male), prostatitis or prostate cancer are plausible diagnoses. The mild elevation in WBC could support an infectious or inflammatory process like prostatitis.
Other Likely Diagnoses
- Urinary Tract Infection (UTI): Although the WBC is only slightly elevated, a UTI could explain the findings, especially if the patient is presenting with urinary symptoms.
- Benign Prostatic Hyperplasia (BPH): This condition can also cause an elevated PSA and might be considered, especially in older males, though it doesn't directly explain the elevated WBC.
- Reactive Lymphocytosis: The elevated absolute lymphocyte count could be a reactive response to a viral infection or another inflammatory condition.
Do Not Miss Diagnoses
- Prostate Cancer with Metastasis: Although less likely with a mildly elevated WBC, missing a diagnosis of prostate cancer with metastasis could be catastrophic. The elevated PSA mandates further investigation.
- Sepsis: Although the patient's WBC is not markedly elevated, any elevation in WBC, especially with an elevated neutrophil count, should prompt consideration of sepsis, particularly if the patient has symptoms suggestive of infection.
- Lymphoproliferative Disorders: While less common, an elevated absolute lymphocyte count could be an early sign of a lymphoproliferative disorder, which would require prompt diagnosis and treatment.
Rare Diagnoses
- Leukemia: A markedly elevated WBC count is typically seen in leukemia, but given the patient's WBC is only slightly elevated, this would be less likely. However, some forms of leukemia, like chronic lymphocytic leukemia (CLL), can present with relatively mild elevations in WBC.
- Myeloproliferative Neoplasms: Conditions like polycythemia vera or essential thrombocytosis could present with elevated cell lines, but the normal hemoglobin, hematocrit, and platelet count make these less likely in this case.
- Parasitic Infections: Certain parasitic infections can cause eosinophilia (elevated eosinophils), but the eosinophil count is normal in this patient, making this diagnosis less likely.