question

[paopaolong]

there is one question in Gojan's note.
An 82 year old man presents with lower back pain and complaints of problems with voiding urine. there is point tenderness over the lower lumbar vertebra. His bladder is percussed at the level of the umbilicus. which of the following tests or procedures is indicated as the first step in the management of this patient?
A. Radionuclide bone scan
B. Prostate specific antigen
C. Digital rectal examination
D. Serum alkaline phosphatase
E. Transrectal ultrasound with biopsy
Answer is C.
I know this is a metastatic prostate cancer. But why do we choose B or E. Why C?

[AUCMD2006]

rule of money, a DRE costs nothing more than an exam glove..so what if you do the DRE and the prostate is normal? woudl you still assume it is prostate CA or would something else be added to the differential. always start out with the simplest most inexpensive test then work your way up to confirm a dx.

[blackwolverine]

Simplicity is the rule my friend...

[lyuda_m@yahoo.com]

Always in examination patients we go from easy to difficult!!!

[lyuda_m@yahoo.com]

I was doctor surgery in Ukraina, worked 7 years in very big emergence hospital and we had "gold rule" in country: We make all men (older than 40 year old) digital examination per rectum. I found for 7 year 42 cases cancer prostate!!! and examination breast all men (gynecomastia+cancer) and all women (182 cases cancer!!! I found personality).