A 62-year-old male presents with two months of increasing nocturia, urinary hesitancy, and a weak urinary stream. The prostate is irregularly enlarged with multiple hard nodules. What is the most likely diagnosis?

• A. Carcinoma of the prostate
• B. Non-specific urethritis
• C. Chronic prostatitis
• D. Benign prostatic hyperplasia

Answer: (D)

On physical examination, irregular enlargement with hard nodules in the prostate is most indicative of prostate cancer. Malignancy tends to create an asymmetric, nodular, and firm prostate, which aligns with the described finding of multiple hard nodules. Benign prostatic hyperplasia, by contrast, usually produces a smooth, enlarged, and more symmetric gland, and the nodularity described here is not typical.

The urinary symptoms—nocturia, hesitancy, and a weak stream—can occur with both cancer and BPH, so the exam finding helps distinguish the two. Chronic prostatitis might cause urinary symptoms and a tender, inflamed prostate, but it wouldn’t typically present as a mass of hard nodules. Non-specific urethritis would present more with urethral symptoms such as dysuria or discharge rather than a nodular prostate.

Therefore, the presence of irregular enlargement with hard nodules points to prostate cancer as the most likely diagnosis.