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  #1  
Old 10-20-2012
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Arrow Billy Step 1 Questions # 42

A 60-year-old man presents to the urologist complaining of diffi culty urinating. He states he frequently gets out of bed in the middle of
the night to go to the bathroom. Once he gets to the bathroom he can’t urinate easily and must “bear down” to do so. He denies any history
of sexually transmitted disease, trauma to the genitourinary tract, or prior genitourinary instrumentation. On rectal examination the patient has an enlarged prostate and one 1-cm area of induration located on the middle posterior aspect of the prostate. He has a prostatespecific antigen level of 6 ng/mL (normal: 0–4 ng/mL), BUN of 20 mg/L, and creatinine of
1.6 mg/L. The patient undergoes a transrectal prostate biopsy, and no dysplasia or atypia is present. Which of the following is the most appropriate treatment?


(A) Brachytherapy
(B) Finasteride
(C) Radical retropubic prostatectomy
(D) Transurethral resection of the prostate
(E) Watchful waiting
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  #2  
Old 10-20-2012
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will go with B not sure either..

thanks
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Old 10-20-2012
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B) seems the least invasive and the most pertinent treatment for these set of symptoms with such findings.
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Old 10-20-2012
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Quote:
Originally Posted by billy View Post
A 60-year-old man presents to the urologist complaining of diffi culty urinating. He states he frequently gets out of bed in the middle of
the night to go to the bathroom. Once he gets to the bathroom he can’t urinate easily and must “bear down” to do so. He denies any history
of sexually transmitted disease, trauma to the genitourinary tract, or prior genitourinary instrumentation. On rectal examination the patient has an enlarged prostate and one 1-cm area of induration located on the middle posterior aspect of the prostate. He has a prostatespecific antigen level of 6 ng/mL (normal: 0–4 ng/mL), BUN of 20 mg/L, and creatinine of
1.6 mg/L. The patient undergoes a transrectal prostate biopsy, and no dysplasia or atypia is present. Which of the following is the most appropriate treatment?


(A) Brachytherapy
(B) Finasteride
(C) Radical retropubic prostatectomy
(D) Transurethral resection of the prostate
(E) Watchful waiting
B.Finasteride...
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Old 10-21-2012
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Correct Answer D is correct

The patient has BPH, which may produce obstructive (hesitancy,weakened and intermittent urinary stream, urinary retention) or irritative (urge
incontinence, nocturia) symptoms. While biopsy is not usually warranted in cases of BPH, DRE in this patient revealed a suspicious nodule requiring further evaluation. In most cases of BPH, DRE reveals a uniformly
enlarged, rubbery prostate without areas of induration.
The patient in this case had an area of induration, suggestive of cancer. Additionally, while BPH may cause mildly elevated levels of PSA, prostate cancer can also result in elevated PSA levels. Therefore, biopsy is
warranted to distinguish between benign and malignant disease. This patient’s biopsy revealed a benign process. BPH can be managed
expectantly with medication, or with surgery, depending on the severity of symptoms and associated fi ndings. This patient reported moderate to severe symptoms. Additionally, his elevated creatinine level suggests that he is in renal failure secondary to obstruction of the prostatic urethra. Therefore, transurethral resection of the prostate is the best treatment
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  #6  
Old 10-21-2012
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Quote:
Originally Posted by billy View Post
The patient has BPH, which may produce obstructive (hesitancy,weakened and intermittent urinary stream, urinary retention) or irritative (urge
incontinence, nocturia) symptoms. While biopsy is not usually warranted in cases of BPH, DRE in this patient revealed a suspicious nodule requiring further evaluation. In most cases of BPH, DRE reveals a uniformly
enlarged, rubbery prostate without areas of induration.
The patient in this case had an area of induration, suggestive of cancer. Additionally, while BPH may cause mildly elevated levels of PSA, prostate cancer can also result in elevated PSA levels. Therefore, biopsy is
warranted to distinguish between benign and malignant disease. This patient’s biopsy revealed a benign process. BPH can be managed
expectantly with medication, or with surgery, depending on the severity of symptoms and associated fi ndings. This patient reported moderate to severe symptoms. Additionally, his elevated creatinine level suggests that he is in renal failure secondary to obstruction of the prostatic urethra. Therefore, transurethral resection of the prostate is the best treatment
thanks for the question and explanation billy...
but i have a doubt.....i always heard medication is the first line of BPH(irrespective of severity)..if no compliance is seen with medication --TURP is done in pts.....
correct me..thanks
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Old 10-21-2012
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i go with TURP
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Old 10-21-2012
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@venky : I think the use of finasteride will prevent further growth or hyperplasia of the organ but what about the hyperplasia that is already present ?? Does DHT cause a decrease in size of cells or something ?? ...... I think the issue about using finasteride depends of the severity of symptoms ... When it comes to a point where it is causing renal failure , TURP is the treatment of choice ( which is also considered to be the gold standard treatment )
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  #9  
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Quote:
Originally Posted by alice View Post
@venky : I think the use of finasteride will prevent further growth or hyperplasia of the organ but what about the hyperplasia that is already present ?? Does DHT cause a decrease in size of cells or something ?? ...... I think the issue about using finasteride depends of the severity of symptoms ... When it comes to a point where it is causing renal failure , TURP is the treatment of choice ( which is also considered to be the gold standard treatment )
thanks ...but there are some studies too showing finasteride decreased prostate size....anyhow let's not complicate ourselves on this topic i guess, as those are some controversial...
thank you
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