A 72-year-old man comes to the physician because of urinary frequency and urgency for 2 weeks. He is especially concerned because last week he also noticed blood in his urine for the first time. He has smoked one pack of cigarettes daily for 44 years. Vital signs are within normal limits. Physical examination shows a nondistended, nontender abdomen; there is no costovertebral angle tenderness. Digital rectal examination shows a mildly enlarged, nontender prostate without palpable masses. Urinalysis shows 50 RBCs/hpf. Cystoscopy is planned for visualization and biopsy of suspected urinary tract cancer. Which of the following features would be most suggestive of a poor prognosis?

Question

A 72-year-old man comes to the physician because of urinary frequency and urgency for 2 weeks. He is especially concerned because last week he also noticed blood in his urine for the first time. He has smoked one pack of cigarettes daily for 44 years. Vital signs are within normal limits. Physical examination shows a nondistended, nontender abdomen; there is no costovertebral angle tenderness. Digital rectal examination shows a mildly enlarged, nontender prostate without palpable masses. Urinalysis shows 50 RBCs/hpf. Cystoscopy is planned for visualization and biopsy of suspected urinary tract cancer.  Which of the following features would be most suggestive of a poor prognosis?

Quizplus · Accepted Answer

Eductional Objective: Urothelial (transitional cell) carcinoma is the most common type of bladder cancer.  Tumor stage is the most important factor for determining prognosis and is based on the depth of invasion into the bladder wall and the degree of regional (eg, lymph nodes) and metastatic spread.  Tumor invasion into the muscularis propria layer of the bladder wall carries an unfavorable prognosis.

A 72-Year-Old Man Comes to the Physician Because of Urinary