Prostate cancer differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Syed Musadiq Ali M.B.B.S.[2] Syed Hassan A. Kazmi BSc, MD [3] Amandeep Singh M.D.[4]

## Overview

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Prostate cancer must be differentiated from benign prostatic hypertrophy, renal cancer, renal stones, bladder cancer, and cystitis.

## Differential diagnosis

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Prostate cancer must be differentiated from:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]

* Benign prostatic hypertrophy (BPH)
* Renal cancer
* Renal stones
* Bladder cancer
* Cystitis
* Glomerulonephritis
* Prostatitis
* Pyelonephritis

Diseases  | Clinical manifestations | Para-clinical findings  | Gold standard

|
|
|

Symptoms | Physical examina
Lab Findings  | Diagnosi
Low back pain  | Fever  | Nausea/

Vomiting

| Urinary symptoms  | Hypertension  | Pitting edema  | Other
Dysuria  | Frequency  | Oliguria
Disease  | Low back pain  | Fever  | Nausea/

Vomiting

| Dysuria  | Frequency  | Oliguria  | Hypertension  | Pitting edema  | Other  | Lab Findings  | Diagnosis method  | Gold standard
Nephrolithiasis[16][17] | \+  | ±  | \+  | ±  | ±  | ±  | –  | –  |

* Radiating pain to groin

* Hypercalciuria
* Hyperoxaluria
* Hypocitraturia
* Hyperuricemia
* Hyperuricosuria

* Ultrasound: Hydronephrosis +/-
* Abdominal CT scan without contrast

| Abdominal CT scan without contrast
Malignancy | Renal cell carcinoma (RCC)[18][13] | \-  | \-  | \-  | \-  | \-  | \-  | ±  | ±  |

* Flank mass

* Anemia
* Hematuria

* Both CT and MRI may be used to detect neoplastic masses that may define renal cell carcinoma or metastasis of the primary cancer. CT scan and use of intravenous (IV) contrast is generally used for work-up and follow-up of patients with renal cell carcinoma.
* The histological pattern of renal cell carcinoma depends whether it is papillary, chromophobe or collecting duct renal cell carcinoma.

| –
Bladder cancer[19][20][21] | \-  | \-  | \-  | \-  | ±  | ±  | \-  | \-  | Suprapubic pain  |

* Anemia
* Hematuria

| Ultrasound, CT scan, Biopsy  | Biopsy
Prostate cancer[22][23] | ±  | \-  | \-  | \-  | ±  | ±  | \-  | \-  | \-  |

* Anemia
* Hematuria

| Ultrasound, CT scan, Biopsy  | Biopsy
Lower urinary tract diseases | Benign prostatic hyperplasia | +/-  | \-  | \-  | \+  | \+  | \-  | \-  | \-  |

* Nocturia
* Other voiding symptoms
* Slow urinary stream
* Splitting or spraying of the urinary stream
* Intermittent urinary stream
* Hesitancy
* Straining to void
* Terminal dribbling

* Urinalysis to rule out UTI
* Elevated BUN/Cr
* High PSA values

* Urine cytology to screen for bladder cancer
* Biopsy to rule out cancer

| Biopsy
Urolithiasis[24][25][26] | \+  | +/-  | \+  | \+  | \+  | \+  | \-  | \-  |

* Flank
* Groin pain

* Urine analysis

* High Cr

| Abdominppelvic CT scan without contrast  | Abdominppelvic CT scan without contrast
Infectious diseases | Pyelonephritis[27][28] | \+  | \+  | \+  | \+  | \+  | \+  | \-  | \-  |

* Delirium
* Headache

* Positive leukocyte esterase test and nitrite test.
* Blood/urine cultures

| CT and ultrasound:

* Enlarged kidneys
* Round swollen kidneys
* Hypodense appearance
* Abscesses may not be present

| \-
Cystitis[29][30] | \-  | \-  | \-  | \+  | \+  | \+  | \-  | \-  |

* Dyspareunia
* Supra pubic tenderness

* Pyuria: > 5-10 WBC/hpf or 27 WBC/microliter
* Positive leukocyte esterase test and nitrite test.
* Positive urine/blood cultures

| Ultrasound:

* Presence of gas in the bladder wall.

* Also, help to detect the presence of a tumor or a stone.

| Urine culture
Prostatitis[31][32] | \-  | \+  | \-  | \+  | \+  | \+  | \-  | \-  |

* Body aches

* Increased leukocytes (>10 per high power field) on CBC
* Bacteria seen on urine culture
* Elevated C-reactive protein
* Transiently elevated PSA (prostate specific antigen) levels

| Ultrasound:

* Focal hypoechoic region located in the peripheral part of the prostate

CT scan:

* Edema of the prostate gland with diffuse enlargement,.

| \-

## References

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1. ↑ Worcester EM, Coe FL (June 2008). "Nephrolithiasis". Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.
2. ↑ Semins MJ, Matlaga BR (February 2010). "Medical evaluation and management of urolithiasis". Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.
3. ↑ Venkatesh L, Hanumegowda RK (June 2017). "Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities". J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.
4. ↑ Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). "Diagnostic significance of clinical and laboratory findings to localize site of urinary infection". Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.
5. ↑ Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). "Acute pyelonephritis: clinical characteristics and the role of the surgical treatment". J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.
6. ↑ Saeed K (2012). "Renal infarction". Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.
7. ↑ Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). "Embolic renal infarction mimicking renal colic". Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.
8. ↑ Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). "The clinical spectrum of acute renal infarction". Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.
9. ↑ Brix AE (2002). "Renal papillary necrosis". Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.
10. ↑ Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). "Renal papillary necrosis: an update". Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.
11. ↑ Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). "Renal cell carcinoma: diagnosis, staging, and surveillance". AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.
12. ↑ Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). "[The role of CT scan in the diagnosis of renal cell carcinoma]". Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.CS1 maint: Unrecognized language (link)
13. ↑ 13.0 13.1 Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
14. ↑ Bratt O, Lilja H (January 2015). "Serum markers in prostate cancer detection". Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.
15. ↑ "Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health".
16. ↑ Hochreiter W, Knoll T, Hess B (February 2003). "[Pathophysiology, diagnosis and conservative therapy of non-calcium kidney calculi]". Ther Umsch (in German). 60 (2): 89–97. doi:10.1024/0040-5930.60.2.89. PMID 12649987.CS1 maint: Unrecognized language (link)
17. ↑ Trinchieri A (February 2013). "Diet and renal stone formation". Minerva Med. 104 (1): 41–54. PMID 23392537.
18. ↑ Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
19. ↑ Pons F, Orsola A, Morote J, Bellmunt J (2011). "Variant forms of bladder cancer: basic considerations on treatment approaches". Curr Oncol Rep. 13 (3): 216–21. doi:10.1007/s11912-011-0161-4. PMID 21360040.CS1 maint: Multiple names: authors list (link)
20. ↑ Metts MC, Metts JC, Milito SJ, Thomas CR (June 2000). "Bladder cancer: a review of diagnosis and management". J Natl Med Assoc. 92 (6): 285–94. PMC 2640522. PMID 10918764.
21. ↑ Rom M, Kuehhas FE, Djavan B (2007). "New findings in bladder and prostate cancer: highlights of the 22nd annual congress of the European association of urology, march 21-24, 2007, berlin, Germany". Rev Urol. 9 (4): 214–9. PMC 2199502. PMID 18231618.
22. ↑ Chung SD, Liu SP, Lin HC (2013). "Association between prostate cancer and urinary calculi: a population-based study". PLoS ONE. 8 (2): e57743. doi:10.1371/journal.pone.0057743. PMC 3581486. PMID 23451265.
23. ↑ Rom M, Kuehhas FE, Djavan B (2007). "New findings in bladder and prostate cancer: highlights of the 22nd annual congress of the European association of urology, march 21-24, 2007, berlin, Germany". Rev Urol. 9 (4): 214–9. PMC 2199502. PMID 18231618.
24. ↑ Hochreiter W, Knoll T, Hess B (February 2003). "[Pathophysiology, diagnosis and conservative therapy of non-calcium kidney calculi]". Ther Umsch (in German). 60 (2): 89–97. doi:10.1024/0040-5930.60.2.89. PMID 12649987.CS1 maint: Unrecognized language (link)
25. ↑ Flannigan R, Choy WH, Chew B, Lange D (June 2014). "Renal struvite stones--pathogenesis, microbiology, and management strategies". Nat Rev Urol. 11 (6): 333–41. doi:10.1038/nrurol.2014.99. PMID 24818849.
26. ↑ Pereira DJ, Schoolwerth AC, Pais VM (March 2015). "Cystinuria: current concepts and future directions". Clin. Nephrol. 83 (3): 138–46. PMID 25685869.
27. ↑ Pereira DJ, Schoolwerth AC, Pais VM (March 2015). "Cystinuria: current concepts and future directions". Clin. Nephrol. 83 (3): 138–46. PMID 25685869.
28. ↑ Rosen DA, Hooton TM, Stamm WE, Humphrey PA, Hultgren SJ (2007). "Detection of intracellular bacterial communities in human urinary tract infection". PLoS Med. 4 (12): e329. doi:10.1371/journal.pmed.0040329. PMC 2140087. PMID 18092884.CS1 maint: Multiple names: authors list (link)
29. ↑ Franco AV (2005). "Recurrent urinary tract infections". Best Pract Res Clin Obstet Gynaecol. 19 (6): 861–73. doi:10.1016/j.bpobgyn.2005.08.003. PMID 16298166.
30. ↑ Franco AV (2005). "Recurrent urinary tract infections". Best Pract Res Clin Obstet Gynaecol. 19 (6): 861–73. doi:10.1016/j.bpobgyn.2005.08.003. PMID 16298166.
31. ↑ John N. Krieger, Ulrich Dobrindt, Donald E. Riley & Eric Oswald (2011). "Acute Escherichia coli prostatitis in previously health young men: bacterial virulence factors, antimicrobial resistance, and clinical outcomes". Urology. 77 (6): 1420–1425. doi:10.1016/j.urology.2010.12.059. PMID 21459419. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
32. ↑ Sharp VJ, Takacs EB, Powell CR (2010). "Prostatitis: diagnosis and treatment". Am Fam Physician. 82 (4): 397–406. PMID 20704171.CS1 maint: Multiple names: authors list (link)

## References

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