What is the appropriate next step if a digital rectal exam (DRE) reveals a hard nodule in the prostate?

A digital rectal exam (DRE) showing a hard nodule in the prostate is a concerning finding that requires further evaluation. The most appropriate next step is to order a prostate-specific antigen (PSA) test. The PSA test measures the level of prostate-specific antigen in the blood, which can be elevated due to prostate cancer, benign prostatic hyperplasia, or prostatitis.

By obtaining a PSA level, healthcare providers can assess the potential risk of prostate cancer. An elevated PSA level, especially when correlated with a hard nodule found during the DRE, may indicate the need for further diagnostic procedures, such as a biopsy, to confirm or rule out cancer.

Taking immediate action, like starting chemotherapy, is not appropriate since a diagnosis must be established first. Scheduling surgery without definitive diagnosis of cancer is premature; surgery is usually considered after a diagnosis is confirmed. Likewise, merely reassessing the nodule in 6 months without further investigation could delay necessary diagnosis and treatment if cancer is present. Thus, conducting a PSA test represents the most rational and clinically sound next step following the finding of a hard nodule during a DRE.