Case Study Questions 1. Identify this patient’s

Case Study Questions 1. Identify this patient’s two major risk factors for prostate cancer. 2. Which two clinical manifestations shown in the physical examination above should concern the primary care provider? 3. Which type of test is the PCP likely to order to establish a definitive diagnosis? 4. Transrectal ultrasonography revealed that the primary tumor was located in less than one-half of one lobe of the prostate gland. MRI scans showed that prostate cancer had not spread to any lymph nodes or other organs but had remained confined exclusively to the prostate. Furthermore, there was no sign that the tumor had penetrated the capsule of the prostate. To which stage has this prostate cancer progressed? 5. List three appropriate treatment procedures for Matthew. 6. What is this patient’s expected 5-year survival rate? Case Study-Prostate Cancer Initial history Matthew is a 53 year old, married, African American male who has come into the clinical for his annual physical examination. He has no specific complaints and denies any difficulties with urination, pain, or swelling. He has no known drug or other allergies and is not currently taking any medications other than naproxen for an occasional headache. There is a significant positive family history for cancer as both the patient’s father and maternal grandfather had a history or prostate cancer. He has a 75 pack year smoking history and continues to smoke. (Pack-years can be calculated from the product of number of packs of cigarettes smoked daily and number of years as a smoker. For example, 74 pack-years can be the result of a 2 packs smoked daily for 25 years). He uses alcohol occasionally. His diet is healthy and includes few saturated fats and many fresh fruits, vegetables and whole grain products. Physical Examination and Laboratory Tests Vital Signs T = 98.0 F; BP = 118/75 sitting, left arm, 120/78 sitting, right arm; P = 90 beats/minute, normal rhythm; RR = 17 breaths/minute, unlabored; ht = 6’2″; Wt = 193 lbs. HEENT, Neck, Lungs, Cardiac HEENT unremarkable, fundi without lesions Neck supple with no adenopathy, thyromegaly, or bruits Bilateral, symmetric, and normal chest expansion with vesicular and bronchial breath sounds S1 and S2 and clear with no rubs, gallops, or murmurs Abdomen, Neurologic Positive bowel sounds throughout; abdomen neither tender nor distended Alert and oriented; cranial nerves II-XII intact; strength 5/5 throughout; DTRs 2 + and symmetric; sensation intact Skin, Extremities Skin intact and warm All peripheral pulses palpable No bruits or edema Digital Rectal Examination Prostate mildly enlarged overall with one distinct, 2-cm indurated nodule on surface PSA History 4 years ago: 1.7 ng/mL 3 years ago: 1.8 ng/mL 2 years ago: 1.7 ng/mL Last year: 2.0 ng/mL Last week: 4.7 ng/mL Laboratory Blood Test Results Na + 146 meq/L WBC Count 6,000/mm3 K + 4.0 meq/L Hct 48% Cl- 103 meq/L RBC count 6.0 million/mm3 Ca +2 9.9 mg/dL Plt 440,000/mm3 Glucose, fasting 70 mg/dL Albumin 3.5 g/dL

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