Snapshot A 58-year-old man presents to his primary care physician for an annual examination. He does not have any acute complaints and feels otherwise healthy. He has a past medical history of hypertension that is adequately controlled with lisinopril. Family history is remarkable for prostate cancer in his father. Digital rectal examination is notable for an asymmetric, nodular prostate. Prostate-specific antigen level is elevated at 15 ng/mL. Introduction Overview malignancy arising from the prostate most prostate cancers are adenocarcinomas arises most commonly in the posterior lobe (peripheral zone) Epidemiology Incidence most common cancer in men more common in older men (> 65 years of age) Risk factors increasing age family history black race Presentation Symptoms asymptomatic in most cases lower urinary tract symptoms e.g., urinary retention Physical exam digital rectal exam (DRE) prostate nodules, induration, or asymmetry Studies Serum labs prostate-specific antigen (PSA) not specific for malignancy (e.g., can be elevated in benign prostatic hyperplasia) Invasive studies biopsy indication confirms the diagnosis and important for pathologic staging provides a Gleason grade Differential Benign prostate hyperplasia differentiating factors symmetric enlargment and firmness of the prostate Treatment Treatment dependent on pathological features, metastasis, and the patient's life expectancy e.g., if patient is already on maintenance GnRH therapy, external beam radiation therapy is used to treat symptomatic metastasis Complications Obstructive uropathy Metastatic spinal cord compression prostate cancer can metastasize to the spine, causing epidural spinal cord compression if metastatic spinal cord compression is suspected or confirmed in a patient with neurologic deficits, initial management includes administration of high-dose steroids to reduce edema and inflammation in patients with suspected spinal cord compression but no neurologic deficits, steroid therapy may not be necessary if neoplastic spinal cord compression is suspected, work-up includes: MRI is first-line imaging modality CT myelography is second-line imaging modality, for patients with contraindications to MRI
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M3.ON.12.3) A 51-year-old man presents to the emergency department with an episode of syncope. He was at a local farmer's market when he fainted while picking produce. He rapidly returned to his baseline mental status and did not hit his head. The patient has a past medical history of diabetes and hypertension but is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 173/101 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for clear breath sounds and a S4 heart sound. Rectal exam reveals a firm and nodular prostate that is non-tender and a fecal-occult sample that is negative for blood. Which of the following is this patient's presentation most concerning for? QID: 102735 Type & Select Correct Answer 1 Benign prostatic hyperplasia 9% (1/11) 2 Normal physical exam 0% (0/11) 3 Prostate abscess 0% (0/11) 4 Prostate cancer 64% (7/11) 5 Prostatitis 18% (2/11) M 10 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M3.ON.12.1) A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management? QID: 103024 Type & Select Correct Answer 1 CT abdomen and pelvis 0% (0/7) 2 Cystourethroscopy 0% (0/7) 3 Transrectal prostate biopsy 86% (6/7) 4 Reassurance 14% (1/7) 5 Repeat PSA test 0% (0/7) M 10 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
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