A 68-year-old man arrives at the office complaining of ongoing back pain for several months. He's a retired veteran who hasn't seen a doctor in years. He has smoked a pack of cigarettes every day for the past 36 years. His blood pressure is 145/85 mm Hg, and his pulse rate is 88 beats per minute. The cardiopulmonary exam is unremarkable. The abdomen is nontender and soft. Tenderness is present over the 10th rib and the L1-L2 vertebral region. The neurologic exam is normal. Increased activity in multiple vertebrae and ribs, corresponding to the patient's painful areas, is revealed by radionuclide bone imaging. Sclerotic lesions matching bone scan areas of increased uptake on routine radiographs are highly suspicious for metastatic cancer. Which of the following additional findings is most likely to be seen in this patient?

Question

A 68-year-old man arrives at the office complaining of ongoing back pain for several months. He's a retired veteran who hasn't seen a doctor in years. He has smoked a pack of cigarettes every day for the past 36 years. His blood pressure is 145/85 mm Hg, and his pulse rate is 88 beats per minute. The cardiopulmonary exam is unremarkable. The abdomen is nontender and soft. Tenderness is present over the 10th rib and the L1-L2 vertebral region. The neurologic exam is normal. Increased activity in multiple vertebrae and ribs, corresponding to the patient's painful areas, is revealed by radionuclide bone imaging. Sclerotic lesions matching bone scan areas of increased uptake on routine radiographs are highly suspicious for metastatic cancer. Which of the following additional findings is most likely to be seen in this patient?

Quizplus · Accepted Answer

Eductional Objective: This patient's sclerotic bony metastases are most likely the result of prostate cancer. Imaging of bone metastases aids in cancer diagnosis by allowing lesions to be classified as:
Osteoblastic (sclerotic) bone lesions are common in metastatic prostate cancer. A common clinical presentation is bone pain; other symptoms include cancer cachexia and urinary symptoms (which are not always present). Prostate cancer is the most common non-skin cancer in men, with African American men being the most vulnerable. On digital rectal examination, an irregular prostate gland suggests the diagnosis, which is then confirmed by biopsy. The tumor marker prostate-specific antigen is frequently elevated.

A 68-Year-Old Man Arrives at the Office Complaining of Ongoing