Differential Diagnosis for a 33-year-old with Reflexed Free PSA

Single Most Likely Diagnosis

• Benign Prostatic Hyperplasia (BPH): Given the patient's age and the relatively high percentage of free PSA (23%), BPH is a likely diagnosis. The free PSA level is often used to differentiate between prostate cancer and BPH, with higher percentages suggesting BPH.

Other Likely Diagnoses

• Prostatitis: This condition, characterized by inflammation of the prostate, can also present with elevated PSA levels and is a common issue in younger men.
• Elevated PSA due to other non-cancerous conditions: Conditions such as prostate stones, recent catheterization, or even recent bike riding can cause an elevation in PSA levels.

Do Not Miss Diagnoses

• Prostate Cancer: Although less likely given the patient's age and the high percentage of free PSA, prostate cancer must be considered, especially if there are other risk factors present (e.g., family history). Missing this diagnosis could be catastrophic.
• Intraductal Carcinoma of the Prostate: A rare but aggressive form of prostate cancer that might not be initially suspected due to its rarity and atypical presentation.

Rare Diagnoses

• Prostatic Intraepithelial Neoplasia (PIN): Considered a precursor to prostate cancer, high-grade PIN could potentially be present, although it's less likely to cause significant PSA elevation on its own.
• Granulomatous Prostatitis: A rare condition that can mimic prostate cancer both clinically and on biopsy, often associated with specific types of infections or autoimmune conditions.