# A 65-year-old African American male client is being evaluated for possible prostate cancer. Which assessment finding would be most significant for the nurse to report to the healthcare provider immediately? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540748 > language: ko > subject: Adult Health ## 문제 A 65-year-old African American male client is being evaluated for possible prostate cancer. Which assessment finding would be most significant for the nurse to report to the healthcare provider immediately? ## 보기 1. Hard, fixed nodule palpated during digital rectal examination **✔ 정답** 2. Mild hesitancy when initiating urination 3. Slightly elevated prostate-specific antigen (PSA) level at 8.0 ng/mL 4. Complaint of occasional nocturia twice per night **정답: 1** ## 해설 A hard, fixed nodule on DRE is highly suspicious for prostate cancer and requires immediate reporting for biopsy. Other symptoms like hesitancy or nocturia are less urgent. ## 심화 해설 Key Assessment Finding in Suspected Prostate Cancer The most significant finding to report immediately is a hard, fixed nodule palpated during a digital rectal examination (DRE). While all the listed findings can be associated with prostate pathology, a hard and fixed nodule is a highly specific physical exam finding that strongly suggests locally advanced or invasive malignancy until proven otherwise [1]. Clinical Reasoning and Pathophysiology The normal prostate gland has a smooth, elastic, and rubbery consistency upon palpation. A malignant lesion typically arises in the peripheral zone of the prostate, which is accessible to the examining finger during a DRE. As cancer cells proliferate, they form a dense mass of fibrous and glandular tissue that feels distinctly hard, often described as "rock-hard" or "woody." The term fixed indicates that the nodule is adherent to surrounding structures, such as the seminal vesicles or pelvic sidewall. This fixation signifies extracapsular extension, a critical finding that immediately upstages the disease and rules out organ-confined treatment options like a radical prostatectomy. This finding requires prompt communication to facilitate urgent urological referral and biopsy planning [1]. Analysis of Other Options While the other options are clinically relevant and require follow-up, they lack the immediate, high-specificity alarm of a fixed nodule: - Mild hesitancy (Option 2) and occasional nocturia twice per night (Option 4) are classic lower urinary tract symptoms (LUTS). These symptoms are more commonly associated with benign prostatic hyperplasia (BPH), which causes obstructive and irritative voiding complaints. In the context of a cancer workup, they are nonspecific and do not independently signal a malignant process requiring immediate, same-day escalation [2]. - A PSA level of 8.0 ng/mL (Option 3) is a laboratory value that falls within the "gray zone" of >4 but ## 임상 시나리오 Clinical Guide: The Fixed Nodule on DRERecognizing the Hallmark of Locally Advanced Prostate Cancer A hard, fixed nodule on digital rectal examination (DRE) is a pathognomonic finding for extracapsular extension of prostate cancer. This signifies tumor adherence to structures like the seminal vesicles or pelvic sidewall, ruling out organ-confined disease. Immediate action is required: urgent urological referral for confirmatory biopsy. Do not delay reporting to monitor lower urinary tract symptoms or repeat PSA testing, as this physical finding independently upstages the disease. CautionDifferentiate from a benign, smooth, rubbery enlargement (BPH). A PSA level of 8.0 ng/mL or symptoms like hesitancy and nocturia are non-specific and do not carry the same immediate alarm for invasive malignancy as a fixed nodule. ## 핵심 개념 - **Digital Rectal Examination** — This is a physical examination method where a finger is inserted through the rectum into the anus to assess the size, shape, and texture (firmness, nodules, tenderness) of the prostate. It is part of prostate cancer screening. - **Prostate-Specific Antigen** — A glycoprotein produced by prostate epithelial cells; its blood level is measured. Elevated levels may suggest prostate cancer, benign prostatic hyperplasia (BPH), prostatitis, etc. - **Benign Prostatic Hyperplasia** — Benign prostatic hyperplasia. Noncancerous enlargement of the prostate gland that compresses the urethra, causing urinary difficulties (hesitancy, frequency, nocturia, weak urine stream). - **Nodule** — Nodule. A small lump or raised area within tissue. A hard, fixed nodule felt during DRE strongly suggests prostate cancer. - **Nocturia** — Nocturia. A symptom of waking up one or more times during the night to urinate. It can have various causes (aging, BPH, heart failure, diabetes, etc.). ## 같은 주제 문제 - [A 68-year-old male client is being evaluated for possible prostate cancer. Which assessmen…](https://mymerci.kr/pages/nclex_q.php?qn_id=540747) - [A 68-year-old male client is being evaluated for suspected prostate cancer. Which assessme…](https://mymerci.kr/pages/nclex_q.php?qn_id=540749) - [A 72-year-old male client with newly diagnosed prostate cancer underwent radical prostatec…](https://mymerci.kr/pages/nclex_q.php?qn_id=540750) - [A 68-year-old male client with newly diagnosed prostate cancer is scheduled for a radical …](https://mymerci.kr/pages/nclex_q.php?qn_id=540751) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._