Question

A 43-year-old man is seen in the emergency department after he noticed scrotal swelling while showering. Finding the enlargement alarming, he is unable to give a definitive answer when asked about the pain. A physical examination reveals a mild swelling on the left side with no apparent discoloration. The man explains that he was involved in a minor motor-vehicle accident approximately two weeks ago but had no specific history of scrotal injury. Although a multitude of tests are ordered, the patient is concerned that he did not order a PSA test. The patient is concerned about prostate cancer and quizzes the physician about his reasoning. Describe prostate cancer, its symptoms, and why the PSA test was not ordered based on the patient’s symptoms.

Answer 1

The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder and can be examined by getting a digital rectal exam. Prostate cancer is a form of cancer that develops in the prostate gland. It is the second-leading cause of cancer deaths for men in the U.S. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. This year, nearly 191,000 men will be diagnosed with prostate cancer.

Growths in the prostate can be benign (not cancer) or malignant (cancer).

Benign growths (like benign prostatic hyperplasia (BPH)

The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:

• Blood in the urine
• Difficulty urinating
• Lower back pain
• Fatigue
• Difficulty breathing
• Jaundice
• In this patient the scrotal swelling may be due to the accident and moreover he doesn't have any other symptoms associated with that.