William J. Catalona, MD, Chief of Urologic Surgery, Washington University School of Medicine, St Louis: A 66-year-old man, during a routine physical examination, was noted to have an area of induration in the right lobe of the prostate. His general health was otherwise good. He had had no symptoms of bladder outlet obstruction and no bone pain. His weight had been stable. He was referred to a urologist for further evaluation. The findings were confirmed on digital rectal examination and he was scheduled for a needle biopsy of the prostate. His medical history and findings from the remainder of the physical examination were normal. Laboratory studies revealed a normal urinalysis, acid phosphatase level, and 12-factor automated analysis (SMA-12), including alkaline phosphatase level. The hemogram was also normal. The needle biopsy revealed a well-differentiated adenocarcinoma of the prostate with tumor being present in cores obtained from both lobes of the prostate.
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