{"id":4948,"date":"2025-01-01T00:36:00","date_gmt":"2025-01-01T08:36:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4948"},"modified":"2025-10-01T11:38:23","modified_gmt":"2025-10-01T19:38:23","slug":"usmle-step-1-question-of-the-day-prostate-nodule","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Prostate nodule"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#Main_Explanation\" >Main Explanation\u00a0\u00a0<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-prostate-nodule\/#References\" >References\u00a0<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong>Today, we&#8217;re looking into prostate cancer, specifically exploring the most common sites of metastasis and their anatomical relevance. Can you identify these locations and discuss the underlying reasons for their prevalence? Reflect on the anatomical pathways and structures involved in the spread of this disease. Strengthen your grasp of this critical aspect of oncology and enhance your clinical acumen regarding prostate cancer metastasis.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 72-year-old man comes to the clinic for evaluation of lower back pain. The pain began four weeks ago, is present throughout the day, and awakens him at night. The patient does not have a history of recent trauma, weakness, or paraesthesias. He does not note any significant changes to the pain when standing or sitting. Past medical history is significant for hypertension. Medications include lisinopril and atorvastatin. The patient smokes 2-3 packs of cigarettes daily and has done so for 36 years. He does not use other recreational drugs or alcohol. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 90\/min, respirations are 20\/min, and blood pressure is 120\/75 mmHg. He is awake and oriented to time, place, and person. Tenderness is noted at the L1-L2 vertebral level. Examination of the external genitalia is non-contributory. Neurological examination reveals normal muscle strength and normal sensory findings. Rectal examination reveals an asymmetric non-tender nodule in the prostate. Straight leg raise testing is negative bilaterally. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is likely to be found upon further evaluation?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Vertebral body compression fracture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Lumbar spinal stenosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Osteolytic lesions in the lumbar spine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Lumbar disc herniation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Osteoblastic lesions in the lumbar spine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Osteoblastic lesions in the lumbar spine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, B, C, or D. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Vertebral body compression fracture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Compression fractures are often a complication of vertebral metastasis. This condition presents with acute lower back pain following falls or associated injury. This patient\u2019s pain has been present for four weeks, and he has no associated trauma to the area.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Lumbar spinal stenosis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Spinal stenosis results from thickening of the ligamentum flavum and presents with insidious onset of low back pain and lower extremity weakness and numbness. Symptoms are often posture-dependent, with the extension of the spine aggravating the pain while spinal flexion relieves the pain. This patient\u2019s pain is not affected by posture.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Osteolytic lesions in the lumbar spine<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Osteolytic lesions are typical of myeloma, melanoma, non-small cell cancer of the lung, and non-Hodgkin lymphoma. Prostate cancer more commonly causes osteoblastic lesions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Lumbar disc herniation<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Disc herniation presents with lumbosacral radiculopathy (pain radiating below the knee) and lower back pain relieved with rest and aggravated with activity. Straight leg raise testing is often positive in these patients. This patient has no radiculopathy symptoms (e.g., radiating pain, paresthesias, weakness) and has a bilaterally negative straight leg test.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation\u00a0\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most common site for prostate cancer metastasis is the bone. Prostate cancer can lead to <strong>osteoblastic lesions in the lumbar spine<\/strong>. This patient presents with chronic back pain over the lumbar spine and an irregular nodule detected on DRE (digital rectal examination). These findings suggest underlying <strong>prostatic cancer with vertebral metastasis<\/strong>.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The<strong> prostate<\/strong> is a glandular fibromuscular organ that surrounds the prostatic urethra at the base of the bladder. Prostatic veins form a plexus surrounding the gland and subsequently drain into the vesical venous plexus and the internal iliac veins. Valveless communications between the <strong>prostatic and vertebral venous plexuses\/Batson\u2019s plexus <\/strong>pose a risk of vertebral metastasis in patients with underlying prostate cancer.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The most common manifestations of vertebral metastasis include insidious pain that develops over weeks to months. With prostate cancer, bony metastatic lesions are typically osteoblastic (sclerotic). DRE in patients with prostatic adenocarcinoma often reveals induration, asymmetry, or palpable nodules in the posterior and lateral aspects of the gland. Complications of vertebral metastasis include pathologic fractures, spinal cord compression (cauda equina syndrome), and neurological deficits. DRE is not considered a screening test for prostate cancer as it is neither sensitive nor specific; however, further investigation is required if abnormal findings are found on a DRE.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"567\" height=\"426\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2024\/12\/Prostatic-Venous-Plexus-step-1.png\" alt=\"An illustration of a male from the side noting:\n* Vesical Venous Plexus\n* Internal vertebral venous plexus\n* Prostatic venous plexus\" class=\"wp-image-4950\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Prostatic-Venous-Plexus-step-1.png 567w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Prostatic-Venous-Plexus-step-1.png?resize=300,225 300w\" sizes=\"auto, (max-width: 567px) 100vw, 567px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Prostatic veins contain valveless communications with the vertebral venous plexus\u2013allowing for vertebral metastasis in patients with prostatic carcinoma, which presents with insidious, localized pain and osteoblastic lesions on imaging.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video on <a href=\"https:\/\/www.osmosis.org\/learn\/Prostate_cancer\">prostate cancer<\/a>.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References\u00a0<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suva LJ, Washam C, Nicholas RW, Griffin RJ. Bone metastasis: mechanisms and therapeutic opportunities. Nat Rev Endocrinol. 2011 Apr;7(4):208-18. doi: 10.1038\/nrendo.2010.227. Epub 2011 Jan 4. PMID: 21200394; PMCID: PMC3134309.&nbsp;<\/li>\n\n\n\n<li>Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004 Apr 15;350(16):1655-64. doi: 10.1056\/NEJMra030831. PMID: 15084698.&nbsp;<\/li>\n\n\n\n<li>Tateishi U, Morita S, Taguri M, Shizukuishi K, Minamimoto R, Kawaguchi M, Murano T, Terauchi T, Inoue T, Kim EE. A meta-analysis of (18)F-Fluoride positron emission tomography for assessment of metastatic bone tumor. Ann Nucl Med. 2010 Aug;24(7):523-31. doi: 10.1007\/s12149-010-0393-7. Epub 2010 Jun 18. PMID: 20559896.&nbsp;<\/li>\n\n\n\n<li>Smith DS, Catalona WJ. Interexaminer variability of digital rectal examination in detecting prostate cancer. Urology. 1995 Jan;45(1):70-4. doi: 10.1016\/s0090-4295(95)96812-1. PMID: 7529449.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL1_2023.png?w=700\" alt=\"\" class=\"wp-image-4972\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_GENERAL1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Want more USMLE\u00ae Step 1-style practice questions? Try Osmosis today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Delve into today&#8217;s USMLE\u00ae Step 1 question on prostate cancer metastasis and understand the anatomical pathways and clinical implications involved.<\/p>\n","protected":false},"author":202,"featured_media":4952,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,16,1366,1369,44],"tags":[733,265,746,84,745,656,743,149,744,185],"class_list":["post-4948","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-do","category-questions","category-step-1-questions","category-step-1","tag-clinical-case","tag-healthcare-training","tag-lower-back-pain","tag-medical-education","tag-metastasis","tag-oncology","tag-osteoblastic-lesions","tag-patient-care","tag-prostate-cancer","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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