A 60-year-old man with hypertension and type 2 diabetes presents with increased frequency of urination, especially at night. He also reports a sensation of incomplete bladder emptying and a weak urine stream. On digital rectal examination, the prostate is enlarged and smooth. What is the most likely diagnosis? A) Prostate cancer B) Acute prostatitis C) Benign prostatic hyperplasia (BPH) D) Urinary tract infection E) Urethral stricture Correct Answer: C) Benign prostatic hyperplasia (BPH) Explanation: Benign prostatic hyperplasia (BPH) is a common condition in older men, characterized by enlargement of the prostate that can cause urinary symptoms such as increased frequency, nocturia, weak stream, and a sensation of incomplete bladder emptying. Prostate cancer (A) typically presents with painless hematuria, back pain, or systemic symptoms, and would not cause the smooth, enlarged prostate typically seen in BPH. Acute prostatitis (B) causes painful urination, fever, and perineal discomfort, along with a tender prostate on rectal examination. Urinary tract infection (D) would be more likely to present with dysuria and pyuria, rather than the enlarged prostate found on examination. Urethral stricture (E) would cause urinary obstruction, but it is more likely to present with a history of trauma or previous instrumentation. Key Tips for PLAB 1: ✅ Enlarged, smooth prostate, urinary symptoms = Benign prostatic hyperplasia (BPH) ✅ Management = Alpha-blockers, 5-alpha reductase inhibitors, and surgical options (e.g., TURP) for severe cases.
