On DRE, you note that a 45-year-old patient has a firm, smooth, non-tender but asymmetrically shaped prostate. The patient has no symptoms and has a normal urinalysis. The patient's PSA is within normal limits for the patient's age
The clinician should:
A. Refer the patient for transrectal ultrasound guided prostate biopsy
B. Obtain an abdominal x-ray of kidneys, ureter, and bladder
C. Recognize this as a normal finding that requires periodic follow-up
D. Obtain urine culture and sensitivity for prostatitis
ANS: C
An asymmetric prostate is typically asymptomatic and not necessarily diagnostic of prostate cancer; asymmetry can be a normal finding on DRE but should be followed periodically to monitor for changes. Age-specific reference ranges for PSA (see Table 11.4) should be used as a guide when there is no previous PSA for comparison. A prostatic nodule found on DRE necessitates a referral to a urologist or radiologist for transrectal ultrasound-guided prostate biopsy and may well be the first indication of the presence of a cancer.
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