American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the March ACP Observer, copyright 2005 by the American College of Physicians.

A 52-year-old man presents as a new patient requesting an annual examination and a serum prostate-specific antigen (PSA) measurement. He exercises, does not smoke and drinks alcohol infrequently. His medical records disclose well-controlled hypertension, a negative exercise tolerance test four years ago, and various laboratory evaluations, all of which were normal. His only medication is atenolol.

Previous health maintenance included a colonoscopy two years ago, and serum PSA values of 4.2 ng/mL one year ago and 3.8 ng/mL two years ago. The patient recalls his prior physician telling him the value was borderline and recommending a repeat measurement in one year.

Physical examination, including digital rectal examination, is unremarkable. Serum PSA value is 5.0 ng/mL.

Which of the following is the most appropriate next step in the management of this patient?

A. Prescribe tamsulosin therapy
B. Perform serial PSA measurements
C. Order free PSA assay
D. Refer for urologic evaluation
E. Prescribe finasteride



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