Differential Diagnosis for BPH with Nocturia, Elevated PSA, and Leukocytosis

Single Most Likely Diagnosis

• Prostatitis: Given the history of BPH, nocturia, elevated PSA (33), and leukocytosis, prostatitis is a highly plausible diagnosis. Prostatitis can cause an elevation in PSA levels and is often associated with urinary symptoms such as nocturia. The presence of leukocytosis suggests an infectious or inflammatory process, which aligns with prostatitis.

Other Likely Diagnoses

• Urinary Tract Infection (UTI): While the primary symptoms suggest prostatitis, a UTI could also explain the leukocytosis and nocturia. An elevated PSA is not typically a direct result of a UTI, but it could be coincidental or related to the patient's BPH.
• Benign Prostatic Hyperplasia (BPH) Exacerbation: Although BPH itself does not typically cause leukocytosis, an exacerbation or worsening of BPH symptoms could contribute to the clinical picture, especially the nocturia. The elevated PSA could be related to the BPH rather than an acute process.
• Prostate Cancer: An elevated PSA of 33 raises concern for prostate cancer, especially in the context of BPH. However, the presence of leukocytosis and nocturia might suggest an additional or alternative diagnosis such as prostatitis.

Do Not Miss Diagnoses

• Septicemia or Urosepsis: Although less likely, given the leukocytosis, it's crucial not to miss a diagnosis of septicemia or urosepsis, which could be life-threatening. These conditions require immediate medical attention.
• Kidney Stones with Infection: If a kidney stone is obstructing the urinary tract and causing an infection, it could lead to severe consequences, including sepsis. The presence of leukocytosis and urinary symptoms necessitates considering this diagnosis.

Rare Diagnoses

• Tuberculosis of the Genitourinary Tract: This is a rare condition in many parts of the world but could present with similar symptoms, including nocturia, elevated PSA, and leukocytosis. It's an important consideration in endemic areas or in patients with risk factors for tuberculosis.
• Granulomatous Prostatitis: This is a rare inflammatory condition of the prostate that could cause an elevated PSA and urinary symptoms. It might be considered if other diagnoses are ruled out and the patient's symptoms persist.