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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]] [mailto:gromero@wikidoc.org]
|QuestionAuthor=[[User:Gonzalo Romero|Gonzalo A. Romero, M.D.]], {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Reproductive
|SubCategory=Reproductive
|Prompt=A 60-year-old patient comes to the outpatient clinic complaining of increased urination throughout the night and difficulty starting and stopping the stream of urine.  He was diagnosed with hypertension 10 years ago, and is currently taking amlodipine.  His vitals are: 67 pulse/min, 16 respirations/min, blood pressure 135/85mmHg and  temperature 37C.  His physical exam is unremarkable.  The patient’s primary care physician orders a PSA (prostate-specific antigen), which is increased.  Which of the following is true about the most likely diagnosis causing this patient’s symptoms?
|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=* '''Beningn prostatic hyperplasia (BPH)''' is common in men older than 50 years old. Clinically it presents with increased frequency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria. It can lead to distention and urinary bladder hypertrophy, hydronephrosis, and subsequent urinary tract infections. It is not considered a premalignant lesion.  Microscopically the gland presents hyperplasia, not hypertrophy.  Its etiology may be due to an age-related increase in estradiol and DHT.  It is characterized by a nodular enlargement of the peri-urethral, which include the lateral and middle lobes which compress the urethra.  It causes an increase in the free prostate-specific antigen (PSA).  
|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  
* '''Prostatic cancer''' it is commonly caused by adenocarcinoma (ADC), which incidence increases with age. Anatomically it is commonly located in the  posterior lobe  or peripheral zone, therefore accesible to the digital rectal examination of the prostate gland, which is felt as a hard nodule.  Prostatic acid phosphatase (PAP) and PSA are used as tumor markers (increase in total PSA, with decrease in free fraction of PSA).  Lately it can cause osteoblastic metastases which can be presented as:  lower back pain and an increase in serum alkaline phosphatase and PSA.
|AnswerA=It is diagnosed by elevated PSA levels
[[File:Gray1153.png|center]]
|AnswerB=It is always preceded by hyperplasia
|AnswerA=Prostatic cancer is preceded by benign prostatic hypertrophy
|AnswerC=It increases total and free PSA equally
|AnswerAExp=See overall explanation
|AnswerD=It is frequently localized in the peripheral zone
|AnswerB=Prostatic cancer increases both total PSA and free PSA
|AnswerE=It is commonly associated with renal failure
|AnswerBExp=See overall explanation
|RightAnswer=D
|AnswerC=Benign prostatic hyperplasia is localized frequently in the posterior lobe of the prostate
|AnswerCExp=See overall explanation
|AnswerD=Prostatic cancer is localized frequently in the lateral lobes of the prostate
|AnswerDExp=See overall explanation
|AnswerE=Benign prostatic hyperplasia increases free PSA
|AnswerEExp=See overall explanation
|EducationalObjectives=BPH is frequently located in the periurethral lobes causing urinary obstructive symptoms. It increases free PSA. Prostatic cancer is frequently located in the posterior lobe accesible by DRE. It increases total PSA, but decreases free PSA
|References=First Aid 2013 reproductive chapter
|RightAnswer=E
|WBRKeyword=Prostate cancer, BPH
|Approved=No
|Approved=No
}}
}}

Revision as of 18:50, 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

Educational Objective:
References: ]]

Approved Approved::No
Keyword
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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