Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a pleasant 75 year old obese African American male.
Patient reports a three month history of constant, dull pain in his lower back that is unrelated to activity level. Pain gets worse at night and does not subside with rest. Patient reports unintentional 20 pound weight loss in the past month, night sweats, and fatigue. He also states he’s had trouble starting his urinary stream for about 6 months, but thought it was just part of aging. He has not noticed any hematuria.
Physical Exam: Vitals- Height 6’3”, weight 255 lbs, BMI 31.9, HR 62, BP 138/92, RR 16, temp 98.6 FCV-regular rate and rhythm, normal intensity S1 and S2, no S3 or S4, no murmur. Resp-lungs clear to auscultation throughout all lung fields. Abdominal-bowel sounds present in all four quadrants, nontender, nondistended, smooth liver edge, spleen is not palpable. Genital/Rectal-palpable nodule present in the prostate with DRE. Musculoskeletal-lumbar vertebra are tender to palpation, no obvious deformity or discoloration
Labs: PSA testing is 52 ug/L