Reference no: EM133297062
Case: A 95-year-old man patient with a medical history of hypertension, type 2 diabetes mellitus (T2DM), stage 3 chronic kidney disease, coronary artery disease, and a cerebrovascular accident presents to you for routine examination. He has no new complaints and says he is feeling fine. He denies smoking, alcohol, or illicit drug use. He has no known allergies. His hypertension and T2DM are well controlled with lisinopril/hydrochlorothiazide 20/12.5 mg daily and glyburide 20 mg twice a day, respectively. He also takes 81 mg aspirin daily.
His last glycated hemoglobin level was 6.2%. His blood pressure reading today was 134/86 mm Hg. All other vital signs are within normal limits, and the physical examination is unchanged from last visit.
Laboratory studies are positive for deficient renal function (glomerular filtration rate = 35), serum glucose level of 144 mg/dL, and prostate specific antigen (PSA) level of 4.5 ng/mL.
You refer him to a urologist for biopsy of the prostate. Results on biopsy confirm localized prostate cancer with a Gleason score of 3.
What is the most appropriate next step in the management of this patient?
1. refer him for radical prostaectomy
2. Immediately start high dose of finasteride
3. Maintain watchful waiting
4. start bracytherapy