08-05-2010, 12:12 PM
d.
Although no nodule is felt on digital rectal exam, the presence of a discrete localized firm region should prompt suspicion for further evaluation by a urologist, including biopsy. Biopsy of this area will likely be recommended. Research reports have defined an abnormal digital rectal examination differently but most include even an asymmetric enlargement of one side of the gland.
Continued PSA monitoring at any frequency is inappropriate. The false negative rate of the PSA is noted by the fact that 25% of men undergoing surgery for prostate cancer have a PSA in the normal range. Ultrasonography of the prostate is only 60% sensitive among men referred for evaluation of abnormal PSA or digital rectal examination. However even if the ultrasonography was normal, further evaluation of the abnormal physical finding would be recommended
Although no nodule is felt on digital rectal exam, the presence of a discrete localized firm region should prompt suspicion for further evaluation by a urologist, including biopsy. Biopsy of this area will likely be recommended. Research reports have defined an abnormal digital rectal examination differently but most include even an asymmetric enlargement of one side of the gland.
Continued PSA monitoring at any frequency is inappropriate. The false negative rate of the PSA is noted by the fact that 25% of men undergoing surgery for prostate cancer have a PSA in the normal range. Ultrasonography of the prostate is only 60% sensitive among men referred for evaluation of abnormal PSA or digital rectal examination. However even if the ultrasonography was normal, further evaluation of the abnormal physical finding would be recommended