gross hematuria evaluation:

urine culture to start and if negative for infection, then PSA, CBC, CMP followed by CT urogram (if normal renal function and no contrast allergy) followed by local cystoscopy and cytology

if UCx +, then treat and reassess for any further gross or microhematuria in 4-6 weeks

can start alpha blocker for voiding bother such as flomax or rapaflo

pending PSA value and urine culture results would determine if any further eval needed here -- prostate MRI, prostate biopsy, etc

Hematuria in this 63 yo man is cancer until proven otherwise. I would check a CT scan of abdomen/pelvis (kidney protocol,) check a PSA, CBC, CMP and PT-INR and refer to urology to visualize the GU tract and biopsy PRN. Once a diagnosis is established a treatment strategy can be planned.

agree with most of the comments. start with CT for kidney stones. Cystoscopy, repeat PSA and mutiparametric mri of the prostate.

He is high risk for Urothelial CA given age, smoking history and presentation.
Patient should get updated labs including CBC to evaluate for anemia and leukocytosis, updated PSA if not within the last year and renal function testing to ensure appropriate for CT with contrast.
Urine needs to be sent for cytology and possible FISH test. Consider a Urine culture as well.
He needs cystoscopy to evaluate the prostate, bladder outlet and bladder for any signs of malignancy and obstruction.
Family history should be obtained especially for GU malignancies.
Cross sectional imaging, preferably CT urogram to evaluate the upper tracts and abdomen.
Further recommendations regarding prostate symptoms to be done after above work up

CT scan abdomen and pelvis, cystoscopy, cytology, PSA and BMP or CMP

cytology and ? mri prostate

Needs a urine cytology and cystoscopy. The Rx w antibiotic if culture positive and tamsulosin for obstruction. Needs ct urogram and prostate sono.

The patient needs a standard battery of tests including upper tract imaging preferably with CT urogram. Also PSA. BMP. Urine cytology and urovyson. Finally a cystoscopy is on order to fully work this patient up.

CT Urogram would be the most prudent now and then a referral to Urology. Likely needs a cystoscopy

I would focus my evaluation into related but different groups. First, I would see him in the clinic to check urine to rule out a urinary tract infection and draw a PSA at that time (assuming no UTI was found). Second, I would order a CT-urogram to evaluate the gross hematuria and see him back in the clinic for a cystoscopy to rule out a bladder or urothelial cancer in this smoker. I would pay attention to his prostate anatomy at that time and if it appeared obstructing I would offer him a trial of an alpha-blocking medication to help with his symptoms. As long as his PSA was stable in the 2.4 range, I would not be concerned about prostate cancer at this time.

I would have urology evaluation with CT urogram; will need info why patient is on ASA and if it was “just prophylaxis” without CAD or stroke history; hold ASA in the interim for gross hematuria: differential is bladder cancer; prostate cancer or UTI. Once Acute issue of GU issues have resolved plan to repeat PSA in next 4-6 weeks. Imaging and cystoscopy will guide. Further management

Recheck PSA, urology referral.

I would repeat the PSA to look at the velocity/trend, obtain CT scan, and also refer to urology for cystoscopy.

I will repeat psa level
will do ct scan of abdomen and pelvis followed by cystoscopy

Urovysion, cytology, Ct Urogram and cystoscopy due to gross hematuria
BMP Psa blood test if not up to date.

Cystoscopy and CT urogram.

Ct Urogram and cysto due to gross hematuria and smoking history.
Check BMP prior to contrast!
Psa blood test if not up to date.

ct and cysto

Given the patient's gross hematuria as well as significant tobacco history, I would recommend a CT urogram followed by cystoscopy. He will also need urine cytology. Is his PSA up-to-date?