docswapna
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A 7O year old man has difficulty initiating urination. digital rectal exam shows an enlarged , firm prostate. an assay for serum psa is 3.5 microg/l(ref range=0-5). exam of tissue obtained on biopsy of the prostate is most likely to show
a.adenocarcinoma
b.glandular hyperplasia
c.chronic prostatitis
d.epithelial dysplasia
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| khorshid
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b
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| alexaE
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a
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| khorshid
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why alexae?:-) because it is firm?
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| young_doc
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The psa is normal.
And even though it's not a 100% specific test, i will have to guess B, as BPH is more likely.
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| alexaE
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still adenocarcinoma
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| alexaE
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oh, psa is within normal limits
you are all right guys a dx of hyperplasia is better
thanks
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| docarchana
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i guess adeno Ca bcos only Ca can be diagnosed by a rectal exam as it is peripheral where as BPH is periurethral
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| khorshid
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I don't agree for BPH they also do rectal exam, eventhough the increase in size is not posteriorly but you can feel the enlargement.
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| alexaE
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as far as i know, PSA cannot make a real difference between BPH and C, thats why its usage to dx- and even screen is questionable. at the same time, people with cancer may have normal PSA many with BPH may have high PSA
rectal exam is the clinical way to dx adenocarcioma- so docarchana is right, but khorshid is right also, enlargement may be felt in those with BPH as well.
maybe a lumpy peripheral prostate would have been a better description for a prostate cancer, plus difficulty initiating only appears late
what do you know guys? is PSA level highly increased early in the course of an adenocarcinoma, and they remain high or lower? in other words is PSA a good test to screen for advanced cancer?
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| young_doc
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Yea you can definitely feel the enlargement in BPH with a rectal exam...even though it's periurethral.
But speaking of AdenoCa being peripheral, it's not very likely to affect urinary flow. (i remember reading that somewhere). So just based on that alone, i would have guess BPH! And the normal PSA just seals the deal.
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| docarchana
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In Ca, prostate is enlarged and hard (stony)
what is the presentation in BPH?
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| alexaE
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i just read that the normal gland is supposed to be firm
they dont say stony rock hard
i guess if they said bumpy...
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| khorshid
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Ok:-),this is from kaplan notes:
Ca presentation:
1.often clinically silent
2. may present with lower back pain (metastasis)
3. advanced localized dis may present with urinary tract obstruction or UTI(uncommon)
dtetction has 3 parts:rectal exam, PSA, biopsy
So to me if it was that advanced that it had caused obstruction signs and symp the psa should have been elevated.
docarchana now that you're here would you please post the "ulcer"'s correct response too?:-) thanks
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| Allison
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b.glandular hyperplasia
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| ManuNastai
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B
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| proctalgia
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Hi Friends,
This is what Dr Goljan says.
Prostate Hyperplasia:- Develops in transitional zone aroud urethra.
Prost. Cancer(PC):- In the peripheral zone/detected by rectal exam.
Urinary retention is more likely in benign than malignant.
*PSA does not disdinguish PC from hyperplasia.
*PSA is not increased after PR exam.
PC- *MC cancer in man
* Age is a risk factor.
*Screening test----> Rectal exam + PSA
* Confirmation---> Transrectal ultrasound with Bx.
Any eldely man with low back pain--> Do a rectal exam to rule out PC.
Adenocarcinoma seems to be correct.
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| pocas
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b
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| ssrpk
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well prostatic hyperplasia can be identified over per-rectal exam, it feels just like thenar and hypothenar eminences only much exagerrated....and yeah its smooth as compared to cancer which indeed has a rough texture!
but again, clinical correlation is a must!
its true tht locally advanced malignancy can lead to symptomns of urinary obstruction but tht is very uncommon....unlike glandular hyperplasia!
had the question mentioned tht pt. has low back pain, SOB, URQ pain....then i wud hv considered malignancy!
answer is definitely glandular hyperplasia!
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| usmle4me
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B
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| linaorvos
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ssrpk
solid explanation!
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