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|SubCategory=Reproductive
|SubCategory=Reproductive
|Prompt=A 60-year-old man presents to the outpatient clinic with complaints of increased urinary frequency and difficulty initiating urination.  He was diagnosed with hypertension 10 years ago, and is maintained on amlodipine.  His heart rate is 67/min, blood pressure is 135/85 mmHg, and  temperature is 37.0 °C (98.6 °F).  His physical exam is unremarkable except for a hard nodule palpated on digital rectal examination.  The physician orders a prostate-specific antigen (PSA) assay that reveals an elevated concentration at 22 ng/mL.  Which of the following is true about the patient's most likely diagnosis?
|Prompt=A 60-year-old man presents to the outpatient clinic with complaints of increased urinary frequency and difficulty initiating urination.  He was diagnosed with hypertension 10 years ago, and is maintained on amlodipine.  His heart rate is 67/min, blood pressure is 135/85 mmHg, and  temperature is 37.0 °C (98.6 °F).  His physical exam is unremarkable except for a hard nodule palpated on digital rectal examination.  The physician orders a prostate-specific antigen (PSA) assay that reveals an elevated concentration at 22 ng/mL.  Which of the following is true about the patient's most likely diagnosis?
|Explanation=Prostate cancer is the most common cancer in men, and the second most common cause of cancer deaths in the in men following lung cancer. Prostatic adenocarcinoma is a slow growing neoplasm whose incidence increases dramatically with increasing age. In fact, the prevalence among patients above 80 years of age may be as high as 80%. The most common location for prostate cancer
|Explanation=Prostate cancer is the most common cancer in men, and the second most common cause of cancer deaths in the in men following lung cancer. Prostatic adenocarcinoma is a slow growing neoplasm whose incidence increases dramatically with increasing age. In fact, the prevalence among patients above 80 years of age may be as high as 80%. The most common location for prostate cancer to develop is the peripheral zone, making the digital rectal exam (DRE) a good method of screening for prostate cancer. In 2011, PSA was removed from the universal screening guidelines given the lack of evidence supporting its benefit. PSA is not used for the diagnosis of prostate cancer, but rather for follow-up after cancer resection. Several derivatives of PSA have been used to increase the sensitivity and specificity of the test. Free/Total PSA is one example. In men with prostate cancer, there is a lower proportion of free PSA causing a lower ratio of free/total PSA. Definitive diagnosis is made by transrectal ultrasound guided biopsies of the prostate gland. Current treatments include transurethral resection or radical prostatectomy both of which may be associated with erectile dysfunction and urinary incontinence. Metastatic disease may be seen in elderly patients presenting for back pain secondary to neoplastic seeding to the lumbar spine (classically osteoblastic). Advanced disease often requires radiation therapy and androgen ablation. It is important to note that prostate cancer does not arise from benign prostatic hyperplasia, and presence of the latter does not increase the risk of cancer.
 
 
|AnswerA=It is diagnosed by elevated PSA levels
|AnswerA=It is diagnosed by elevated PSA levels
|AnswerB=It is always preceded by hyperplasia
|AnswerB=It is always preceded by hyperplasia
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|AnswerE=It is commonly associated with renal failure
|AnswerE=It is commonly associated with renal failure
|RightAnswer=D
|RightAnswer=D
|Approved=No
|WBRKeyword=Prostate cancer, Prostate specific antigen, PSA, Prostate, BPH, Benign prostatic hyperplasia, Cancer,
|Approved=Yes
}}
}}

Revision as of 20:02, 15 September 2014

 
Author [[PageAuthor::Gonzalo A. Romero, M.D., Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Reproductive
Prompt [[Prompt::A 60-year-old man presents to the outpatient clinic with complaints of increased urinary frequency and difficulty initiating urination. He was diagnosed with hypertension 10 years ago, and is maintained on amlodipine. His heart rate is 67/min, blood pressure is 135/85 mmHg, and temperature is 37.0 °C (98.6 °F). His physical exam is unremarkable except for a hard nodule palpated on digital rectal examination. The physician orders a prostate-specific antigen (PSA) assay that reveals an elevated concentration at 22 ng/mL. Which of the following is true about the patient's most likely diagnosis?]]
Answer A AnswerA::It is diagnosed by elevated PSA levels
Answer A Explanation AnswerAExp::
Answer B AnswerB::It is always preceded by hyperplasia
Answer B Explanation AnswerBExp::
Answer C AnswerC::It increases total and free PSA equally
Answer C Explanation AnswerCExp::
Answer D AnswerD::It is frequently localized in the peripheral zone
Answer D Explanation AnswerDExp::
Answer E AnswerE::It is commonly associated with renal failure
Answer E Explanation AnswerEExp::
Right Answer RightAnswer::D
Explanation [[Explanation::Prostate cancer is the most common cancer in men, and the second most common cause of cancer deaths in the in men following lung cancer. Prostatic adenocarcinoma is a slow growing neoplasm whose incidence increases dramatically with increasing age. In fact, the prevalence among patients above 80 years of age may be as high as 80%. The most common location for prostate cancer to develop is the peripheral zone, making the digital rectal exam (DRE) a good method of screening for prostate cancer. In 2011, PSA was removed from the universal screening guidelines given the lack of evidence supporting its benefit. PSA is not used for the diagnosis of prostate cancer, but rather for follow-up after cancer resection. Several derivatives of PSA have been used to increase the sensitivity and specificity of the test. Free/Total PSA is one example. In men with prostate cancer, there is a lower proportion of free PSA causing a lower ratio of free/total PSA. Definitive diagnosis is made by transrectal ultrasound guided biopsies of the prostate gland. Current treatments include transurethral resection or radical prostatectomy both of which may be associated with erectile dysfunction and urinary incontinence. Metastatic disease may be seen in elderly patients presenting for back pain secondary to neoplastic seeding to the lumbar spine (classically osteoblastic). Advanced disease often requires radiation therapy and androgen ablation. It is important to note that prostate cancer does not arise from benign prostatic hyperplasia, and presence of the latter does not increase the risk of cancer.

Educational Objective:
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::Prostate cancer, WBRKeyword::Prostate specific antigen, WBRKeyword::PSA, WBRKeyword::Prostate, WBRKeyword::BPH, WBRKeyword::Benign prostatic hyperplasia, WBRKeyword::Cancer
Linked Question Linked::
Order in Linked Questions LinkedOrder::