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A 63-Year-Old Man Comes to the Physician for a Periodic

question 678

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A 63-year-old man comes to the physician for a periodic health evaluation.  He reports nocturia once or twice per night, and he has noticed a decrease in the size and force of his urinary stream over the past six months.  These symptoms mildly affect his quality of life.  There is no additional past medical or surgical history and review of symptoms is otherwise unremarkable.  His father suffered from benign prostatic hyperplasia and underwent prostate surgery.  His mother passed away from breast cancer at the age of 74.
On examination, he appears healthy.  His blood pressure is 128/82 mm Hg and pulse is 72/min.  General physical examination is within normal limits.  On digital rectal examination, his prostate is mildly enlarged.  There is a firm 1 cm nodule in the right lateral lobe of the prostate.
Laboratory results are as follows:
A 63-year-old man comes to the physician for a periodic health evaluation.  He reports nocturia once or twice per night, and he has noticed a decrease in the size and force of his urinary stream over the past six months.  These symptoms mildly affect his quality of life.  There is no additional past medical or surgical history and review of symptoms is otherwise unremarkable.  His father suffered from benign prostatic hyperplasia and underwent prostate surgery.  His mother passed away from breast cancer at the age of 74. On examination, he appears healthy.  His blood pressure is 128/82 mm Hg and pulse is 72/min.  General physical examination is within normal limits.  On digital rectal examination, his prostate is mildly enlarged.  There is a firm 1 cm nodule in the right lateral lobe of the prostate. Laboratory results are as follows:   Which of the following is the best next step in this patient's management? A) Order endorectal coil MRI B) Reassessment of symptoms in 6 months C) Repeat PSA in 6 months D) Schedule transrectal ultrasound guided prostate biopsy E) Start tamsulosin
Which of the following is the best next step in this patient's management?


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