Rosh Internal Medicine Boost Practice Exam

Which patient history factor would heighten concern for prostate cancer in a man with a PSA level of 4.0?

1. African-American race

2. Exposure to nickel

3. History of benign prostatic hyperplasia

4. History of smoking

The correct answer is: African-American race

The association between African-American race and an increased risk of prostate cancer is well documented in medical literature. African-American men have a higher incidence of prostate cancer compared to men of other races. This disparity is significant enough that it is recommended that African-American men begin screening for prostate cancer at an earlier age than their white counterparts. This heightened risk is likely due to a combination of genetic, environmental, and socioeconomic factors. Therefore, if a man with a PSA level of 4.0, which is typically within the normal range but could be concerning depending on other factors, is of African-American descent, this aspect of his medical history would indeed heighten the concern for prostate cancer. In contrast, while exposure to nickel, a history of benign prostatic hyperplasia, or a history of smoking may have associations with prostate health, they do not carry the same level of risk for prostate cancer as factors tied to race and genetic predisposition. These additional factors could contribute to health concerns but do not specifically intensify the risk for prostate cancer as solidly as African-American race does.