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Soru

Zorluk: KolayUrologic Surgery

During a routine health maintenance examination, a 64-year-old African American male reports waking up twice a night to urinate but denies any dysuria, gross hematuria, or bone pain. His past medical history is notable for hypertension managed with lisinopril. Vital signs are within normal limits. Digital rectal examination reveals a distinctly firm, irregularly shaped nodule on the left posterior lobe of the prostate gland. Laboratory studies show a serum prostate-specific antigen (PSA) level of 7.8 ng/mL. Which of the following is the most appropriate next step in the management of this patient?

  1. Transrectal ultrasound-guided core biopsy of the prostateCevap
  2. B
    Prescription for a four-week course of oral ciprofloxacin
  3. C
    Reassurance and repeat prostate-specific antigen testing in six months
  4. D
    Computed tomography scan of the abdomen and pelvis
  5. E
    Transurethral resection of the prostate

Cevap

Transrectal ultrasound-guided core biopsy of the prostate
The correct answer is transrectal ultrasound-guided core biopsy of the prostate. This patient presents with a classic sign of prostate cancer: a firm, irregular nodule on digital rectal examination (DRE). Whenever a suspicious nodule or induration is palpated on DRE, a prostate biopsy is mandatory to rule out malignancy. An elevated prostate-specific antigen (PSA) level further increases the suspicion for cancer, but the abnormal DRE alone is an absolute indication for tissue sampling.

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1
Evaluate the clinical presentation and physical exam findings.
The patient is an older male with an elevated PSA (7.8 ng/mL) and a distinctly firm, irregular nodule on digital rectal examination.
Identifying abnormal exam findings is critical to distinguishing between benign conditions (like BPH) and malignant processes.
2
Determine the significance of the prostatic nodule.
A hard, irregular prostatic nodule is the classic clinical sign of prostate cancer.
Prostate cancer often arises in the peripheral zone of the prostate and is palpable on examination, unlike BPH which typically affects the transitional zone.
3
Select the appropriate diagnostic intervention.
A prostate biopsy is required to obtain tissue for histologic diagnosis.
Malignancy cannot be confirmed or staged without a tissue sample, making a biopsy the mandatory next step.

Anahtar Kavram

The discovery of a firm, distinct nodule on digital rectal examination is highly suspicious for prostate cancer and requires prompt evaluation with a transrectal ultrasound-guided prostate biopsy, regardless of the PSA level.
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Urologic Surgery

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