A 68-Year-Old Man Comes to the Office Due to Intermittent

A 68-year-old man comes to the office due to intermittent, painless blood in his urine.  He has no other symptoms.  The patient uses transdermal testosterone for chronic hypogonadism and erectile dysfunction.  He has smoked a pack of cigarettes daily for 40 years; he drinks 2 shots of vodka every day and 2 glasses of wine once a week.  He works as an operations manager for a large beverage company and frequently travels to Mexico.  Vital signs are within normal limits.  Abdominal examination shows no abnormalities.  On digital rectal examination, the prostate is smooth with no nodules.  Urinalysis is positive for >50 red blood cells/hpf; there are no casts or dysmorphic blood cells.  Urine cytology is positive for malignant cells.  Renal ultrasonogram reveals normal kidneys.  Which of the following is a major risk factor for this patient's current condition?

A) Alcohol use
B) Occupation
C) Testosterone therapy
D) Tobacco smoking
E) Travel history

Correct Answer:

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