A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling. Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth. The PSA is 1.2. What is the most appropriate management strategy for you to follow at this time?

A 63-year-old man presents to the office with hematuria, hesitancy, and dribbling.

Digital rectal exam (DRE) reveals a moderately enlarged prostate that is smooth.

The PSA is 1.2.

The most appropriate management strategy to follow at this time is:

Explanation:

This 63 year-old-man is at  his elderly stage, meaning that it may have brought the enlargement of the prostate, as the DRE revealed, squeezing the urethra moderately and causing difficulty with urination such as a intermittent flow or dribbling, hematuria and hesitancy, so an urine flow study might be helpful to detect reduced urine flow associated with BPH (Benign Prostatic Hyperplasia).

Although his PSA level of 1.2 nanograms per milliliter (ng/mL) of blood is still in the normal range, a test must be performed to determine how fast is the PSA level is increasing, as it is associated with prostate cancer.

A questionnaire must be filled out to determine the type and severity of symptoms and if they have impacted his routine life.

Digital rectal examination (DRE): The physician inserts a gloved finger into the rectum (located next to the prostate) and feels the back of the prostate. Prostate cancers can sometimes be detected as lumps or bumps on the prostate here.

Depending on the results the patient could get a cystoscopy, which is a test that allows the physician to inspect the inside of the prostate, urethra channel and bladder, using a mini-camera inserted within a thin tube.

If the doctor finds cancer suspicious data, he might order a transrectal ultrasound, a transabdominal ultrasound or a prostate magnetic resonance imaging (MRI).

BPH is the most common urologists diagnosed disorder of the prostate gland in males between the ages of 45 and 76.

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