question: Q:A 60-year-old man comes to the physician for a routine health maintenance examination. He feels well. Five years ago, he underwent a colonoscopy, which was unremarkable. He has no history of serious illness except for an episode of poststreptococcal glomerulonephritis at the age of 10 years. His father died of bladder carcinoma at the age of 55 years. The patient works at a rubber factory. He has smoked one pack of cigarettes daily for the past 25 years. He drinks 1–2 cans of beer per day. He takes no medications. He has never received any pneumococcal vaccination. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 120/80 mm Hg. Digital rectal examination shows mild symmetrical enlargement of the prostate with no masses. Which of the following is the most appropriate next step in management?? 
  {'A': 'Recommend colonoscopy', 'B': 'Discuss PSA assessment with patient', 'C': 'Administer pneumococcal conjugate vaccination', 'D': 'Obtain CT urography', 'E': 'Obtain renal ultrasound'},