Prostate cancer: The Daily PANCE Blueprint
A 65-year-old man presents with difficulty in urination and a decreased stream. His digital rectal examination reveals a hard, nodular prostate. His PSA level is 5.5 ng/mL. What is the most appropriate next step in the diagnosis of this patient's condition?
A. Transrectal ultrasound-guided prostate biopsy
B. Immediate initiation of androgen deprivation therapy
C. Magnetic resonance imaging (MRI) of the prostate
D. Repeat PSA testing in 6 months
E. Urine cytology
Answer and topic summary
The answer is A. Transrectal ultrasound-guided prostate biopsy
In a patient with a hard, nodular prostate and an elevated PSA level, the most appropriate next step is a transrectal ultrasound-guided prostate biopsy. This procedure is the standard method for diagnosing prostate cancer, allowing for tissue sampling and histopathological examination.
Incorrect Answers:
B. Immediate initiation of androgen deprivation therapy – This is a treatment for prostate cancer, not a diagnostic step. A definitive diagnosis via biopsy is required before initiating treatment.
C. Magnetic resonance imaging (MRI) of the prostate – While MRI can provide detailed imaging of the prostate and may be used in the staging of prostate cancer, it is not the initial diagnostic step in a patient with a suspicious DRE and elevated PSA.
D. Repeat PSA testing in 6 months – Given the patient’s clinical presentation and elevated PSA, delaying diagnostic evaluation with a repeat PSA test in 6 months could result in a missed or delayed diagnosis.
E. Urine cytology – This is not a standard diagnostic test for prostate cancer. It is more commonly used in the diagnosis of bladder cancer.
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