A 72-year-old male has a nine-month history of reduced urinary flow, nocturia, hesitancy, and dribbling. On examination, the prostate is non-tender, enlarged, firm and smooth with no nodules. What is the most likely diagnosis?

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

Answer: (A)

Obstructive urinary symptoms in an older man with a prostate that is enlarged but smooth and non-tender point toward benign prostatic hyperplasia. BPH arises from hyperplasia of the glandular tissue in the transition zone, gradually narrowing the urethral channel and causing weak stream, hesitancy, nocturia, and dribbling. On physical exam, a uniformly enlarged, smooth, non-tender prostate fits BPH well. Prostate cancer, in contrast, tends to produce a hard, nodular, and possibly asymmetric prostate and may feel like a focal lump or irregularity. Chronic prostatitis usually yields a tender, sometimes boggy gland with pain, fever, or malaise. Non-specific urethritis presents more with urethral discharge and dysuria rather than progressive obstructive symptoms. Taken together, the presentation best fits benign prostatic hyperplasia.