Differential Diagnosis for a 60-year-old Male with Increased Frequency of Micturition and Rising PSA

• Single most likely diagnosis:
  • Benign Prostatic Hyperplasia (BPH): This is the most common cause of increased frequency of micturition in older men. The significant increase in PSA from 1.8 to 4.8 over a short period could be due to prostatic inflammation or infection, but in the context of BPH, it warrants further investigation to rule out other causes.
• Other Likely diagnoses:
  • Prostatitis: Given the rapid increase in PSA, prostatitis (infection or inflammation of the prostate) is a plausible diagnosis. It can cause urinary frequency and an elevated PSA.
  • Early Prostate Cancer: Although the biopsy last year was normal, the significant rise in PSA levels over a short period necessitates consideration of prostate cancer, especially given the patient's age.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Prostate Cancer with Rapid Progression: Despite the previous normal biopsy, a rapid increase in PSA could indicate aggressive prostate cancer. Missing this diagnosis could have severe consequences.
  • Neurogenic Bladder: Conditions affecting the nervous system, such as stroke, spinal cord injury, or multiple sclerosis, can cause urinary frequency. Although less likely, this diagnosis is critical due to its implications for the patient's neurological health.
• Rare diagnoses:
  • Prostate Abscess: A rare condition that could cause an acute increase in PSA and urinary symptoms.
  • Bladder Cancer: Less common than prostate issues in men of this age group but could present with similar symptoms and should be considered, especially if hematuria is present.
  • Interstitial Cystitis: A chronic condition causing bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can mimic those of BPH or prostatitis but are less common in men.