Differential Diagnosis I: Bacterial Prostatitis
Bacterial prostatitis is an inflammation of the prostate gland caused by infiltration of bacteria from a urinary tract infection. The bacteria, most commonly E.Coli, travels through the urethra infecting the prostate, in turn stimulating inflammation (Honan, 2018). Bacterial prostatitis most commonly affects men between the ages of 30-50 years old, and it may follow a procedure such as catheterization or cytoscopy (McCance & Huether, 2019). The inflamed prostate will often become enlarged and painful and the patient may experience dysuria, nocturia, urinary retention, increased frequency or urgency of urination, and possible urethral discharge. In elevated cases, the patient may manifest signs of infection such as malaise, high fever, chills, and polynephritis. Bacterial prostatitis can be diagnosed with a urinalysis demonstrating the presence of microorganisms and treated with antibiotics. While both bacterial prostatitis and prostate cancer can show increased prostate specific antigen (PSA) levels, bacterial prostatitis is distinguished from prostate cancer since the inflammation should be reduced and the urinary flow restored with antibiotics. In prostate cancer, microorganisms would not cause the infection and would not be relieved through antibiotic pharmacotherapy. The patient, H.C., does not have bacterial prostatitis since the inflammation has been chronic for many months and a urinalysis showed no presence of microorganisms in the urine content.
[Comparative photograph or normal prostate to prostatitis] (2018). Retrieved from https://urologyspecialistsnc.com/prostatitis
Differential Diagnosis II: Benign Prostatic Hyperplasia (BPH)
Benign prostatic hyperplasia (BPH) is a condition of the prostate gland in which it continues to grow abnormally throughout the life span. It is caused by an unbalance in the individual’s endocrines, in particular the androgens, estrogens, gonadotropins and prolactins (McCance & Huether, 2019). The imbalanced hormones affect the growth stimulatory/inhibitory factors, and as a result the cells in the prostate gland have an increased reproduction rate. The enlarged prostate can cause chronic inflammation, urinary obstruction and/or retention, increased frequency of urination, intraabdominal pressure, bladder/kidney infections and hydronephrosis. BPH can be diagnosed with a digital rectal exam (DRE) revealing a large, rubbery, non-tender prostate gland (Honan, 2018). Additionally, the healthcare provider may order diagnostic tests to check urodynamics since complications of BPH may be a gradual dilation of the ureters and kidneys, changes in the bladder wall, and urinary tract infections as a result of urinary stasis. Treatment for BPH includes alpha-adrenergic blockers and 5-alpha-reductase inhibitors which work to relax smooth muscles, improving urinary flow. These medications also block the conversion of testosterone to dihydrotestosterone which is often associated with prostate growth (Honan, 2018). Furthermore, surgery may be performed, possibly implanting a stent, to restore urinary flow. While the inflammation caused by BPH may raise PSA levels similar to prostate caner, BPH will have different results from the rectal exam and show abnormal endocrine levels. H.C. is not diagnosed with BPH because a test performed of his endocrines revealed a normal level.
Mayo Clinic. (2018). Benign Prostatic Hyperplasia. Retrieved from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-new-steam-treatment-for-benign-prosatic-hyperplasia/
Differential Diagnosis III: Prostate Intraepithelial Neoplasia (PIN)
Prostate intraepithelial neoplasia (PIN) is a disorder that is not yet well understood. Many sources believe PIN is a precursor lesion to prostate cancer (McCance & Huether, 2019), however, it is not malignant and cannot metastasize. It is found in 9% of all prostate cancer diagnostic biopsies, which signals this is a precursor to prostate cancer (Brawer, 2005). PIN is a condition of increased and disorganized growth of the cells in the prostate following repeated injuries and cell death. The cell injuries can be a result of oxidative stress, toxins, or urine that has infiltrated the prostate gland. While it is not cancerous in this stage, it can lead to prostate cancer years later. There may be no clinical manifestations of PIN as it originates, however, the neoplasm may continue to grow and encroach on the bladder and urethra causing urinary obstruction. If the growth invades the urethra, blood may be found in the urine. Similar to the first two differential diagnoses, both PIN and prostate cancer will show increased levels of PSA (McCance & Huether, 2019), but PIN can only be diagnosed through a biopsy. PIN can be thought of as an intermediate disorder of the prostate, bridging benign hyperplasia to a diagnosis of prostate cancer (Brawer, 2005). While H.C. may have presence of prostate epithelial neoplasia as well as prostate cancer, these would need to be diagnoses with a biopsy. Based on H.C.’s symptoms, negative urinalysis and normal hormonal levels, H.C. is a good candidate for a prostate biopsy to determine if he has PIN cells present and/or invasive carninoma.
