A 64-year-old man presents to the (ED) because of an inability to urinate for the past 24 hours.
In addition, he complains of an unintentional weight loss of 20 lb over the past 6 months , night sweats, and generalized fatigue. On examination, he is thin and in moderate distress. His BP is 168/92 mm Hg, heart rate is 102 beats per minute, temperature is 37.7°C (98.8°F),
and respiratory rate is 22 breaths per minute. The abdominal examination reveals
a tender mass in the suprapubic area.
rectal examination, the prostate is firm, nontender, and somewhat irregular.
What is the most likely diagnosis
How would you confirm the diagnosis
What is the next step in treatment
A 64-year-old man presents with an inability to void for the past 24 hours
and a tender mass in the lower abdomen. The patient has signs and symptoms
suggestive of prostate cancer, including unintentional weight loss, night sweats, a
decrease in energy, and an enlarged irregular firm prostate gland.
• Most likely diagnosis: Acute urinary retention likely due to prostate cancer.
• Confirming the diagnosis: Thorough history and physical examination including a rectal examination, urinalysis, electrolytes and renal function tests, along
with bedside ultrasound, if available. Prostate-specific antigen may help in the
diagnosis of neoplastic disease if results will be available in the ED.
• Next steps in treatment: Draining the bladder by inserting a urethral catheter
should relieve the patient’s pain; if not, a suprapubic catheter can be placed.
Treatment of the underlying disease process is also necessary.
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