The Daily PANCE and PANRE Question 1

A 52-year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate?

1. Order a serum acid phosphatase level
2. Initiate prazosin and schedule a follow-up appointment in 6 weeks
3. Refer the patient for an ultrasound of the prostate and order a PSA level
4. Reassure the patient and schedule a follow-up appointment in six months
5. Initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks

Answer: C

Refer the patient for an ultrasound of the prostate and order a PSA level

This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as a diffuse enlargement, and not a discrete nodule.