Differential Diagnosis

• Single most likely diagnosis
  • Benign Prostatic Hyperplasia (BPH): The patient's symptoms of occasional slow stream and nocturia, along with a prostate size of approximately 30 grams on DRE and 26 grams on TRUS, are consistent with BPH. The patient's family history of BPH also supports this diagnosis.
• Other Likely diagnoses
  • Chronic Prostatitis: The patient has a history of prostatitis, which could be contributing to his symptoms of slow stream and nocturia.
  • Retrograde Ejaculation: The patient's complaint of low semen volume could be due to retrograde ejaculation, which is often associated with diabetes, certain medications, or surgical procedures, but can also be idiopathic.
  • Hypogonadism: The patient's thyroid abnormalities and low semen volume could be related to hypogonadism, which can cause infertility and low libido.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Prostate Cancer: Although the patient's PSA is low (0.3), it is essential to continue monitoring and consider biopsy if there are any changes in symptoms or PSA levels.
  • Renal Cell Carcinoma: The patient has a septated renal cyst, which, although likely benign, requires regular follow-up to rule out malignancy.
  • Testicular Cancer: The patient's complaint of low semen volume and difficulty conceiving could be related to testicular cancer, which is a rare but potentially life-threatening condition.
• Rare diagnoses
  • Ejaculatory Duct Obstruction: This is a rare condition that can cause low semen volume and infertility.
  • Seminal Vesicle Dysfunction: This is a rare condition that can cause low semen volume and infertility.
  • Neurogenic Bladder: This is a rare condition that can cause urinary retention, slow stream, and nocturia, but is less likely given the patient's normal post-void residual and uroflowmetry results.