A 70-year-old male nursing home resident with a history of benign prostatic hyperplasia and moderate dementia saw his primary care physician for a routine visit. His screening prostate-specific antigen (PSA) level was found to be slightly elevated to 6.7 ng/mL; a repeated PSA test 2 months later revealed a level of 18.2 ng/mL. The patient was referred to urology to address concerns about an aggressive prostate cancer. A computed tomographic (CT) scan of the abdomen and pelvis revealed a 5.1-cm mass in the ascending colon with adjacent lymphadenopathy, multiple liver lesions, and sclerotic foci in the pelvic bones—all consistent with metastatic colon cancer. His urologist referred him to a gastroenterologist, who deferred further intervention pending a discussion with the primary care physician.