A 64-Year-Old Man Comes to the Physician for Follow-Up of an Abnormal

A 64-year-old man comes to the physician for follow-up of an abnormal test.  He was hospitalized a week earlier for an episode of acute urinary retention provoked by amitriptyline.  His other medical problems include post-herpetic neuralgia, hypertension, hyperlipidemia, and a stable abdominal aortic aneurysm.  He is a former smoker and his father had prostate cancer.  Physical examination during the admission showed a moderately enlarged, nontender prostate with no nodularity.  The obstruction was relieved by a Foley catheter, and amitriptyline was stopped.  The patient has had no voiding difficulties or other urinary symptoms since being discharged.  Blood tests at the time of hospital admission showed a white blood cell count of 12,000/µL, creatinine of 1.4 mg/dL, and serum prostate-specific antigen of 7.5 ng/mL (normal <4 ng/mL).  No prior prostate-specific antigen levels are available for comparison.  Which of the following is the most appropriate next step in management of this patient?

A)Consult a urologist for transurethral resection of the prostate
B)Order computed tomography scan of the pelvis
C)Refer for cystoscopy
D)Repeat prostate-specific antigen test in 6-8 weeks
E)Schedule transrectal ultrasound with prostate biopsy

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