A 45-year-old African-American minister comes to your clinic for a general physical examination. He has not been feeling very well for about 3 months, including night sweats and a chronic low-grade fever of 100 to 101 degrees. He denies any upper respiratory symptoms, chest pain, nausea, constipation, diarrhea, blood in his stool, or urinary tract symptoms. He has had some lower back pain. He has a past history of difficult-to-control high blood pressure and high cholesterol. He has had no surgeries in the past. His mother has diabetes and high blood pressure. He knows very little about his father because his parents divorced when he was young. He knows his father died in his 50s, but he is unsure of the exact cause. The patient denies smoking, drinking, or drug use. He is married and has three children. On examination he appears his stated age and is generally fit. His temperature is 99.9 degrees and his blood pressure is 160/90. His head, ears, nose, throat, and neck examinations are normal. His cardiac, lung, and abdominal examinations are also normal. On visualization of the anus there is no inflammation, masses, or fissures. Digital rectal examination elicits an irregular, asymmetric, hard nodule on the otherwise normal posterior surface of the prostate. Examination of the scrotum and penis are normal. Laboratory results are pending. What disorder of the anus, rectum, or prostate is mostly likely in this case?

Question

Quizplus · Accepted Answer

Prostate cancer often presents with few symptoms and can sometimes be found on routine digital rectal examination. It is more common at a younger age in African-American men, and PSA screening, if indicated, begins at age 40, ten years earlier than in other races. Palpation on digital rectal examination can reveal a hard, irregular, asymmetric nodule, but can also reveal an asymmetry in texture between the two lobes.

A 45-Year-Old African-American Minister Comes to Your Clinic for a General