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A 63-year-old male presented with urinary hesitance, frequency and nocturia. Digital rectal exam revealed a large, nodular and rubbery prostate with no hard regions. The serum prostatic specific antigen was 6 ng/ml (ref. range 0-4 ng.ml), thus transrectal ultrasound and prostatic biopsies were performed, followed by transurethral resection of the prostate.
Fifteen years later, he presents with low back pain of several months duration. Further questioning revealed recurrent urinary hesitancy with a recent onset of dysuria.
Digital rectal exam revealed a hard and irregular prostate.
Laboratory data included alkaline phosphatase: 386 U/L (ref. rage 38-126 U/L) and prostatic specific antigen 103 ng/ml (ref. range0-4 ng/ml).
A transrectal biopsy of the prostate was performed. A radionuclide bone scan revealed widepsread bot spots and an x-ray of the spine revealed numerous radiodense bony lesions. A repeat transurethral resection of the prostate and bilateral orchiectomy were performed.
1. List the most common or proposed etiologic agent of acute bacterial prostatitis, chronic bacterial prostatitis and chronic abacterial prostatitis.
2. Describe the pathological and clinical features of nodular hyperplasia or BPH (benign prostatic hypertrophy). Describe the role of 5-alpha-reductase in the pathogenesis of BPH.
3. Describe the incidence, pathological features and clinical features of prostatic carcinoma along with the importance of grading and staging in progress.
4. Explain the value of digital rectal exam, transrectal ultrasound, serum prostatic specific antigen and radionucleic bone scan in diagnosing and staging prostatic carcinoma.
- What is the most likely Diagnosis?
- What is the most likely histologic findings?
- Give the differential diagnosis.
- Discuss the management.