q91 - medmle

[ArchivalUser]

A 55-year-old black man presents for an annual examination. His medical history includes sickle cell trait and hypertension. His medications include hydrochlorothiazide, diltiazem, and atenolol. He has stable nocturia, urinating once each night. Digital rectal examination discloses an asymmetric prostate gland. The right lobe is slightly larger, and the anterior portion feels firmer than the rest of the gland but no discrete nodule is noted. Serum prostate-specific antigen (PSA) concentration is 3.2 ng/mL and has been 2.8 to 3.2 ng/mL for the previous 4 years.
What do you recommend for this patient?
A. Continued annual PSA monitoring
B. Follow-up PSA measurement in 3 to 6 months
C. Determination of free/total PSA ratio
D. Biopsy of the prostate gland
E. Transrectal ultrasonography of the prostate gland

[ArchivalUser]

E, should be

[ArchivalUser]

is it not.....D ??

[ArchivalUser]

https://health.google.com/health/ref/Prostate+cancer

[ArchivalUser]

i feel E

[ArchivalUser]

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