Nodular hyperplasia and cancer of prostate

Case Study 7.2 – Nodular Hyperplasia and Cancer of Prostate

Irving Olson, a 75-year-old man presented with urinary hesitancy, frequency, and nocturia. Digital rectal examination revealed a large, nodular, and rubbery prostate gland with no hard regions. The serum PSA was 6 ng/mL (reference range 0-4 ng/mL). Transrectal ultrasound examination was performed, and prostatic biopsy specimens were obtained, which were negative for tumor, followed by a transurethral resection of the prostate gland.

Fifteen years later, he presented with low back pain of several month duration. Further questioning revealed recurrent urinary hesitancy with recent onset of dysuria. Digital rectal examination revealed a hard and irregular prostate gland. Laboratory data included alkaline phosphatase 386 U/L (reference range 38-126 U/L) and PSA 103 ng/mL (reference range 0-4 ng/mL). A transrectal biopsy of the prostate gland was performed. A radionuclide bone scan revealed widespread hot spots, and an x-ray of the spine revealed numerous radiodense bony lesions.  A repeat transurethral resection of the prostate gland and bilateral orchiectomy were performed.

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