Question

D.P. is a 63-year-old man who has been experiencing progressive difficulty with initiating the urinary stream and frequently needs to get up in the night three or more times to urinate. A prostate-specific antigen (PSA) is obtained and a prostate examination performed. The PSA is not significantly elevated. The prostate is enlarged.

Case Questions

1. What is the likely cause of DP's urinary problem?
2. What is the danger of leaving this untreated?
3. What further testing would be helpful in evaluating the degree of urinary obstruction?
4. How reliable is the PSA in distinguishing between benign and malignant enlargement of the prostate? Is further testing indicated
5. What are the treatment options for D.P.?

Answer 1

1. the likely cause for dp's urinary problem is benign prostatic hyperplasia. it is one of the most common causes of urinary problems in elderly males. benign prostatic hyperplasia is a condition in which prostate gland enlarges

2. if this condition is untreated, it might lead to complete retention of urine due to bladder outlet obstruction, which is a surgical emergency

3. cystoscopy is used to evaluate the degree of urinary obstruction. it helps in examination of prostatic part of urethra, the degree of stenosis

4. psa is a non specific test used in the diagnosis of prostatic cancers. psa protein is produced by both malignant and non-malignant cells of prostate. other conditions with elevated psa are bph, prostatitis. for age group of 60-69 yrs, normal psa levels are <4ng/ml. if there is increased psa levels in blood, biopsy is to be done to ruleout malignancies