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A 51 year-old man visits his physician for a routine physical examination. He has no health complains. He smokes 1 pack of cigarettes and drinks a cup of wine daily for 30 years. He has no significant past history and takes no medications. He has no significant family history and both his parents are healthy. Physical examination and blood tests are normal.

What is the test recommended to be done next?

A- Chest x-ray
B- Liver function tests
C- Kidney function tests
D- Colonoscopy
E- Prostate-specific antigen (PSA) test
http://medical-usmle.com/?p=890
 

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Why not PSA? The incidence of prostatic carcionoma is higher than colorectal CA. The incidence is as follows:
1. Prostate
2. Lung
3. Colorectal
First, prostate cancer usually has a symptomatic presentation unlike colorectal cancer which is very subtle in the beginning as occult blood in the stool.
Second, PSA isn't specific!!! even a value of more than 4 can be benign prostatic hyperplasia! That's why PSA isn't recommended by the US guidelines but colonoscopy is indicated in the US guidelines at ages later than 50 years

Lung cancer is the number one killer malignancy in total (male and female) elderlies , why don't we do CXR? that's because it's non-specific and also not very sensitive early on (unlike colonoscopy which has decreased the death rate in colon cancer patients due to early recognition)

hope that made it clear.
 
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