can you help me respond to this discussion post using high level references from the last 5 years?

After evaluating the HPI and PE provided for the 65-year-old African American male, the most likely diagnosis is benign prostatic hyperplasia (BPH). The first cue provided, frequent urination approximately every 45 minutes for the past 5 months, does not help to narrow down the list of differential diagnoses because polyuria is associated with a wide range of conditions. A urinary tract infection can present with the urgency and frequency that the patient is experiencing. However, the patient denied dysuria, odor, difficulty voiding, or discharge which means he is less likely to have an infection. The findings from the digital rectal exam included an enlarged, firm, smooth, symmetrical prostate which is a hallmark of BPH (UptoDate, 2025a). Another differential diagnosis that was considered is prostate cancer. The findings from the patient's DRE make this less likely as the prostate might present as asymmetric, hard, and nodular if the patient had cancer (UptoDate, 2025a). A third differential diagnosis that was considered is diabetes. The patient admitted that he has not had a physical in 10 years and bloodwork in 5 years, and in that time he could have developed conditions that have been left untreated. Poorly managed diabetes over time can reduce bladder sensation, cause incomplete emptying, and polyuria (UptoDate, 2025a). A CMP and HgbA1c should be obtained to screen for diabetes, however, BPH is still a more likely diagnosis given the HPI and PE provided. A urinalysis is done for all patients with possible BPH or urinary symptoms to look for signs of other conditions like infection, diabetes, or kidney issues (UptoDate, 2025a). A PSA test isn't required to diagnose BPH, but it should be measured before starting a 5-alpha-reductase inhibitor (5-ARI), since the medicine lowers PSA levels and may affect future prostate cancer screening (UptoDate, 2025a). In additon, for patients showing signs of BPH or urinary issues, it's important to use a bladder scanner to measure how much urine remains in the bladder after they go to the bathroom. This is called the postvoid residual (PVR) and helps identify urine retention (UptoDate, 2025a). We use the American Urological Association Symptom Index (AUA-SI and /International Prostate Symptom Score (IPSS) to measure how bothersome a man's urinary symptoms are and track changes over time (UptoDate, 2025a). The score, together with how much the symptoms affect his daily life, sorts patients into mild, moderate, or severe groups. If lifestyle changes haven't helped and symptoms are moderate to severe, medical treatment is recommended. When the prostate is enlarged, a 5-ARI should be given alongside the alpha-blocker since 5-ARIs take several months to show benefit, whereas alpha-blockers like tamsulosin work within days (UptoDate, 2025b). This patient should be started on tamsulosin 0.4 mg once daily which is the initial choice for symptom relief (UptoDate, 2025b).

References

UpToDate. (2025a, January 27). Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia. https://www.uptodate.com/contents/clinical-manifestations-and-diagnostic-evaluation-of-benign-prostatic-hyperplasia?search=benign+prostatic+hyperplasia&source=search_result&selectedTitle=2~131&usage_type=default&display_rank=2

UpToDate. (2025b, May). Medical treatment of benign prostatic hyperplasia. https://www.uptodate.com/contents/medical-treatment-of-benign-prostatic-hyperplasia?search=bph+treatment&source=search_result&selectedTitle=1~131&usage_type=default&display_rank=1