| Patient male, age 63 years, civil servant, was admitted on March 27, 2002 with the main complaint of progressive voiding difficulty for more than six months. (Hospital admission number 475125, Pathology slide number: 20022437).About six months ago, for no obvious reasons the patient started presenting with voiding difficulty, initially there was a decrease in urinary force, followed by intermittent force of stream and the sensation of incomplete bladder emptying, urgency, frequency, nocturia 3-4 times. Symptoms were not accompanied by pain in urination, gross hematuria, abdominal and lumber pain, chills, fever, abdominal distension, difficult defecation, bloody stools etc, Medical treatment with tamsulosin and finasteride failed to control the symptoms effectively. Ultrasound of the prostate at our hospital out patient department revealed a space occupying lesion of the prostate (prostate size of 3.5.4.5.4.3cm3, with nodular changes, irregular margins, discontinuous coarse envelop, heterogeneous resonance and numerous irregular low resonance regions could be seen) and was admitted with the initial diagnosis of prostate cancer.Past medical history: patient was healthy without major medical complaints, and was not allergic to medicines.Physical examination at the time of admission: T: 37.1℃, P: 76bpm, R: 20bpm, Bp: 130/85mmHg. The patient was conscious, cooperative, with normal development, moderate nutrition, independent movement. No abnormal pigmentation of the skin and sclerae, no enlarged superficial lymph node, no deformity of head was observed. Neck was soft and trachea were centrally located, thyroid was not enlarged, and jugular vein was not distended. Thorax was symmetric without deformity, bilateral respiratory sounds were clear without rales, heart size and point of maximal impulse were normal, heart rate was 76 bpm and rhythmic, without murmurs in each valve areas. Abdomen was flat and soft, without visible peristalsis, tenderness, rebound tenderness and abdominal mass. There was no percussion tenderness in area of kidneys, anus and external reproductive organs were normal. There was no percussion tenderness of the vertebrae and the movement of the extremities was normal, physiological reflexes were present and pathological reflexes were absent. Digital rectal examination (knees to chest position): prostate was moderately enlarged, shallow median groove, surface uneven, a hard and nontender nodule could be palpated in the left lobe.Admitting diagnosis: prostate cancerRelated examination result after admission:1. Laboratory tests: Blood routine, stool routine, liver and kidney function test,3electrolytes, clotting function were normal. HBsAg (-), Anti-HCV (-), Anti-HIV(-), TP-Ab (-), Urine-Rt showed: urine protein (-); RBC 32 cells/L; WBC 227cells/L. Blood-PSA: 54ng/ml, fPSA:3.2ng/ml.2. ECG: Sinus rhythm, basically normal ECG.3. Radiologic examination: Chest X-ray was normal, no bone destruction of thoracic vertebrae was seen, no iliac bone and lumber vertebrae destruction was observed in pelvic X-ray examination.4. Ultrasound examination: prostate size of 3.54.5.4.3cm3 [about 50.3 grams], with nodular changes, irregular margins, discontinuous coarse envelop, heterogeneous resonance and numerous irregular low resonance regions could be seen. Conclusion: a space occupying lesion of the prostate.5. Cystoscopy: considerable resistance was felt during insertion, Volume of bladder was 500 millilitre.bladder neck was elevated, ureter orifice was clear and like crack, trabeculum and ventricle formation could be seen inside the bladder, mucous was white in prostatic urethra, Many irregular processes were seen in the prostate surface.6. CT examination: Several nodular, irregular lesions could be seen with the CT value of 53Hu, prostate envelop was discontinuous and coarse, the lesion had signs of extracapsular infiltration, no enlarged lymph nodes were seen. Conclusion: a space occupying lesion of the prostate.7. Radionuclide whole body bone scan: no abnormal radionuclide concentra...
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