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  #1  
Old 02-18-2012
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Question Screening for Prostate Cancer?

A 60-year-old man with celiac sprue presents to the doctor for an annual check-up. He is in relative good health and has a family history of coronary artery disease; his brother had a myocardial infarction at age 55 years. He has a blood pressure of 128/78 mm Hg and heart rate of 70/min. He mentions that his friend has just been diagnosed with prostate cancer and wants to know what screening test would be appropriate for him.
What is the recommended screening test for prostate cancer in this patient?

(A) Cystoscopy
(B) Digital rectal examination and prostate specific antigen
(C) Prostate-specific antigen alone
(D) Transrectal needle biopsy
(E) Yearly history and physical examination
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  #2  
Old 02-18-2012
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the ans is B...
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Old 02-18-2012
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(B) Digital rectal examination and prostate specific antigen
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  #4  
Old 02-18-2012
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Default I would probably answer E

E. Yearly history and physical

Although the real recommendation is neither for nor against PSA screening. If, after discussing the risks and benefits of screening with his physician, a patient still wants to be screened, then PSA and DRE would be the appropriate screen. However, it is not recommended by the American Cancer Society or the U.S. Preventative Services Task Force - only by the American Urological Association (working up prostate cancer represents a great deal of their income stream) - since most evidence points to overdiagnosis and overtreatment, i.e. the harm of PSA testing may outweigh the benefit.
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  #5  
Old 02-18-2012
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Dre + psa....?????
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Old 02-18-2012
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American Cancer Society recommendations for prostate cancer early detection
The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.
The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).
After this discussion, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.
Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.
Because prostate cancer grows slowly, those men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.
Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient's health, values, and preferences.

PSA+DRE HE IS 60 FORGOD SAKE
Age

Age is the strongest risk factor for prostate cancer. Prostate cancer is very rare before the age of 40, but the chance of having prostate cancer rises rapidly after age 50. Almost 2 out of 3 prostate cancers are found in men over the age of 65.
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  #7  
Old 02-18-2012
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Quote:
Originally Posted by hs04 View Post
American Cancer Society recommendations for prostate cancer early detection
The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.
The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).
After this discussion, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.
Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.
Because prostate cancer grows slowly, those men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.
Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient's health, values, and preferences...
But they are not recommending screening - they are recommending discussion about screening. I don't know how current the USMLE is kept, but PSA screening is controversial right now, with the heaviest weight on no routine screening.
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Old 02-18-2012
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ans is B. but i thought PSA is not screening method. so i did last option. not convinced still...
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  #9  
Old 03-16-2012
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Choice E is the Answer.
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Old 03-16-2012
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(B) Digital rectal examination and prostate specific antigen
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  #11  
Old 03-16-2012
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The ans is B . though there is no recommendation for Prostate screening in pt <75yrs. This is in u world.
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  #12  
Old 02-06-2013
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The USPSTF recommends against PSA-based screening for prostate cancer (May 2012).
http://www.uspreventiveservicestaskf...rscreening.htm
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  #13  
Old 02-06-2013
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Quote:
Originally Posted by patient doctor View Post
The USPSTF recommends against PSA-based screening for prostate cancer (May 2012).
http://www.uspreventiveservicestaskf...rscreening.htm
Unless the patient asks for screening. So, the answer is (B) DRE+PSA
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  #14  
Old 02-06-2013
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Originally Posted by Novobiocin View Post
Unless the patient asks for screening. So, the answer is (B) DRE+PSA
In the vignette the patient asks what screening would be appropriate. If we follow USPSTF, we would have to answer to the patient that "the science tells us ... there is a very small potential benefit and significant potential harms". Then if the patient, decides against this recommendation that "even a small possibility of benefit outweighs the known risk of harms", then yes we would do it, but that was not the question here. The question was what would be appropriate. I don't think we can say DRE+PSA would be the appropriate answer to give to the patient, not based on USPSTF at least.
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  #15  
Old 02-06-2013
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Quote:
Originally Posted by patient doctor View Post
In the vignette the patient asks what screening would be appropriate. If we follow USPSTF, we would have to answer to the patient that "the science tells us ... there is a very small potential benefit and significant potential harms". Then if the patient, decides against this recommendation that "even a small possibility of benefit outweighs the known risk of harms", then yes we would do it, but that was not the question here. The question was what would be appropriate. I don't think we can say DRE+PSA would be the appropriate answer to give to the patient, not based on USPSTF at least.
His friend has been diagnosed with prostate cancer and he is very worried. He is literately asking to be screened. He is your patient so you have to do something to relieve his worry and since you cannot rule out cancer you have to screen him. Also, there are other organizations which recommend screening and it's upto you, as a doctor, to follow whichever guidelines.
In the end, it's your patient, so it's your call.
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  #16  
Old 02-06-2013
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Go with ans..(E) Yearly history and physical examination
PSA should not done, unless the patient clearly asking for PSA as screening tool for him after he knows the benefit and harm of the test.
Quote:
“Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.
—USPSTF Co-Chair Michael LeFevre, M.D., M.S.P.H.
May 22, 2012
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Old 02-07-2013
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Quote:
Originally Posted by heartbeat View Post
Go with ans..(E) Yearly history and physical examination
PSA should not done, unless the patient clearly asking for PSA as screening tool for him after he knows the benefit and harm of the test.
But the question asked is "What is the recommended screening test for prostate cancer in this patient?"

Even if you forget the recommendations none of the other chices makes sense as a possible answer to the question.
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  #18  
Old 02-09-2013
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Quote:
Originally Posted by Novobiocin View Post
But the question asked is "What is the recommended screening test for prostate cancer in this patient?"

Even if you forget the recommendations none of the other chices makes sense as a possible answer to the question.
As you know doing PSA is not recommended cuz of significant harms and very small benefit, and on the other side no harm from taking HX or doing examination.
I picked that answer cuz i measured it with the similar concept in UW which state that; Detailed Hx and physical examination is the most effective way to screen a low risk population for presence of underlying heart disease (e.g HOCM in athletes).
This means that Hx and examination can be use as screening tools.
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  #19  
Old 02-13-2013
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Quote:
Originally Posted by heartbeat View Post
As you know doing PSA is not recommended cuz of significant harms and very small benefit, and on the other side no harm from taking HX or doing examination.
I picked that answer cuz i measured it with the similar concept in UW which state that; Detailed Hx and physical examination is the most effective way to screen a low risk population for presence of underlying heart disease (e.g HOCM in athletes).
This means that Hx and examination can be use as screening tools.
Have you reviewed UW question ID 4612.........recommends PSA + DRE as screening ??
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  #20  
Old 04-22-2014
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DRE AND PSA should not done together for screening as prostatic massage provides false positive values.
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Old 04-22-2014
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Quote:
Originally Posted by tyagee View Post
A 60-year-old man with celiac sprue presents to the doctor for an annual check-up. He is in relative good health and has a family history of coronary artery disease; his brother had a myocardial infarction at age 55 years. He has a blood pressure of 128/78 mm Hg and heart rate of 70/min. He mentions that his friend has just been diagnosed with prostate cancer and wants to know what screening test would be appropriate for him.
What is the recommended screening test for prostate cancer in this patient?

(A) Cystoscopy
(B) Digital rectal examination and prostate specific antigen
(C) Prostate-specific antigen alone
(D) Transrectal needle biopsy
(E) Yearly history and physical examination



In my opinion this topic is very controversial and will not be worded as it is above. Instead the patient may ask what are screening options for him which makes the question much easier and much less controversial.
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  #22  
Old 04-22-2014
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i remember similar question on UW but the answer was no screening recommended ..i would chose E....
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  #23  
Old 04-22-2014
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no screening is recommended unless the patient insists
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  #24  
Old 04-22-2014
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this question is too controvertial and wont show up on the real exam like this.


if the patient DOES ask for screening, then yea PSA+DE, latest uworld says it
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  #25  
Old 04-23-2014
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in mtb2 PG 351 says if patient ask then do PSA then if u find high PSA with palpable mass do biopsy.if no mass found do transrectal US if mass seen do biopsy if not then multiple blind biopsies...

nothing said about DRE,,,confused more
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  #26  
Old 04-24-2014
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Quote:
Originally Posted by DrAGA View Post
in mtb2 PG 351 says if patient ask then do PSA then if u find high PSA with palpable mass do biopsy.if no mass found do transrectal US if mass seen do biopsy if not then multiple blind biopsies...

nothing said about DRE,,,confused more
DRE is the means to assess if there is a palable mass
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  #27  
Old 09-11-2014
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There is NO recommendations, BUUUUT either way you should offer DRE+PSA. There is a question similar in UW.
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  #28  
Old 09-28-2015
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Default Prostate Cancer Medication

Hello, everyone! It’s very nice to meet all of you. I’m 63 and am about to begin some prostate cancer treatments. The doxorubicin they’re prescribing me seems manageable price-wise. They’re telling me that I should also look into Viagra to go with the doxorubicin. My issue is that I’m not making a lot of money, right now, and I was wondering if anyone had any ideas as to how I can save some money. Unofficially, my Dr. suggesting looking into alternatives such as “generics” and gave me some reassurance that Canadian pharmacies might be a good option but I’m very nervous about getting into something I know nothing about and risking my health. Does anyone happen to have any insight about this, or has anyone ordered from any of these sources? Please let me know as soon as possible. Feel free to message me privately if you prefer that to posting publicly. Thank you so much for your time, support, and allowing me to join such a great group of people for my own education.
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Old 09-29-2015
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I had a couple of people send me some information and did some research on my own, which I’m currently reviewing. It seems like I might be able to save some money from one of these online places. I don’t have too many chances at this. I’ve narrowed it down to four places that I’m considering ordering from. My favorite one, so far, is a place in Canada that offers “trackable shipping”, allows me to order online with my credit card, and is offering me some free samples and a discount code for my first order. Just wanted to share my progress so far.
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Old 10-02-2015
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Good news! I went with a company called “CanadaPharmacyRX”. Just type “CanadaPharmacyRX” into Google and the site is the first result. Their prices were really great, they offered to increase my order for free, and on top of everything else, they gave me a coupon code to save myself even more. I don’t know how long the coupon will last but feel free to use mine if you can (an additional 20% off). The coupon they gave me is “CPRX20”. Once I receive my order, I’ll share my experience but I feel really good about it and even read about them through my research on some of the other forums. Hope you all are having a very blessed day and I’m VERY grateful for all of your help and information!
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Old 10-03-2015
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Even a small possibility of benefit outweighs the known risk of harms", then yes we would do it, but that was not the question here. The question was what would be appropriate. I don't think we can say DRE+PSA would be the appropriate answer to give to the patient, not based on USPSTF at least.
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