A 72 years old Dayaram underwent routine medical examination. Digital rectal examination shows a nodule on prostate. Serum examination shows elevated PSA levels. What is the next step of investigation?
The appropriate screening examinations for prostate cancer include a serum PSA and DRE. On the basis of an elevated PSA or an abnormal DRE, the patient should be referred for a transrectal ultrasound-guided prostate biopsy. In general, six to twelve cores are taken for evaluation; areas that are abnormal on DRE may receive more biopsy attempts. Also know: Prostate specific antigen (PSA) is a protein produced and secreted by both normal prostate and prostate cancer cells. It provides a sensitive but not highly specific screening test, as it is also elevated with BPH, inflammation, and infection of the prostate. The proposed cutoff is 4.0 ng/mL, but studies have shown that 15% of men with normal PSA levels will have prostate cancer and 2% will have high-grade prostate cancer. Ref: Pienta K.J. (2009). Chapter 96. Prostate Cancer. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e.
CT scan pelvis
IVP
Prostatic massage for examination of secretions
Transrectal ultrasound-guided prostate biopsy