What is the oncologist's first step for a patient with mid-thoracic back pain and prostate cancer?

In the scenario where a patient with prostate cancer presents with mid-thoracic back pain, the oncologist's initial priority is to rule out potential complications that could arise from the cancer, such as spinal cord compression. This condition occurs when a tumor exerts pressure on the spinal cord or surrounding structures, leading to significant neurological deficits.

Scheduling an MRI is critical as it provides detailed imaging of the spine, allowing for a thorough evaluation of any compressive lesions. Detecting spinal cord compression early is essential to prevent irreversible damage and to guide timely intervention, which may involve steroids or surgical decompression. This step is particularly important in patients with a known history of cancer, where there is a higher risk of metastasis affecting the spine.

Other options, while relevant in different contexts, do not address the immediate concern of potentially life-altering spinal issues. For example, initiating pain management without understanding the underlying cause of pain might mask serious conditions like spinal cord compression. Similarly, referring to physical therapy might not be appropriate without prior imaging to ensure the safety of such interventions. Ordering blood tests for prostate-specific antigen may be useful for monitoring cancer progression, but it does not directly address the acute presentation of back pain in the context of potential metastasis. Thus, the