anastamosis
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A 66-year-old African-American man is admitted to the hospital with complaints of constant low back pain for the last six weeks. The pain is insidious in onset, and is progressively getting worse. It does not radiate down his legs, and is not associated with any neurological symptoms. He has a history of hypertension, diabetes mellitus, and prostrate cancer treated with radical prostatectomy six months ago. His medications include aspirin, amlodipine, and metformin. You suspect vertebral metastasis from the prostrate cancer, and a radionuclide scan confirms your suspicion of the osteoblastic bony metastatic disease. Which of the following is the most appropriate initial treatment for this patient?
A. Leuprolide alone
B. Flutamide alone
C. Diethylstilbestrol alone
D. Chemotherapy with mitoxantrone
E. Leuprolide and flutamide
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| Ivonne
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Palliative radiation and antiandrogen(Leuprolide)--------->A
Complete androgen blockade with leuprolide and flutamide has more side effects and the benefit is very modest.
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| anuba
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B Flutamide
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| anastamosis
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No !!!  its none of these
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| anastamosis
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LHRH agonist monotherapy is contraindicated in patients with painful vertebral metastases and severe ureteral obstruction. These symptoms get worse during the initial testosterone surge seen in the first week of therapy. In such cases, an antiandrogen (e.g., flutamide) is given for one week before starting LHRH agonist monotherapy to block the effects of the initial testosterone surge.
its E.
IVONNE, you are right according to the Sep 2 UW Q bank explanations, but the Step 3 UW Q bank gives the above expanation.
I couldnt verify it from any text though.
So i need your opinion. ACCEPT it or REJECT it?
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| Ivonne
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I answered E in UW and i got it wrong so things are different for step 3 Ok I will check emedicine
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92/99/pass/ECFMG certified/4 US LoRs/GC/extensive USCE/2004 grad/appl 29 IM Prog, IV/Rej: 3/0 "I must, I can and I will"
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| arlete
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Please, let us know, guys... 
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| anastamosis
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I am waiting for your response IVONNE
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