Question

a 66-year-old male tells you he has been experiencing frequent urination. you perform lab work and discover that his acid phosphatase is significantly elevated. his physical exam reveals a mushy and boggy prostrate. what is the most probable differential diagnosis?
a) uti
b) prostate cancer
c) benign prostatic hypertrophy
d) prostatitis

Explanation:

• UTI (Urinary Tract Infection): Usually presents with symptoms like dysuria (painful urination), urgency, and may have positive urine culture findings (e.g., bacteria in urine). There is no direct link to acid phosphatase elevation or a boggy prostate in the context of a simple UTI.
• Prostate cancer: Acid phosphatase (prostatic acid phosphatase - PAP) was historically used as a marker (though now prostate - specific antigen - PSA is more commonly used). A hard, irregular prostate is more typical for prostate cancer, not a boggy one.
• Benign prostatic hypertrophy (BPH): Common in older men (this patient is 66). Symptoms include frequent urination (due to bladder outlet obstruction). However, acid phosphatase is not typically elevated in BPH.
• Prostatitis: Can cause symptoms like frequent urination. In acute prostatitis, the prostate may be tender, swollen, boggy, and warm. Also, in some cases (especially in chronic bacterial prostatitis or acute prostatitis), acid phosphatase levels can be elevated.

Answer:

d) prostatitis