An 81 year old afro-caribbean man presents with pain in his lower back and hip. He complains of waking up in the middle of the night to go to the washroom and often he wets himself before reaching the toilet. He also has to urinate much more frequent than in the past and has terminal dribbling. What is the SINGLE most likely underlying diagnosis?
A. Benign prostatic hyperplasia
B. Prostatitis
C. Bladder carcinoma
D. Prostate carcinoma
E. Urinary tract infection
His age, ethnicity and urgency points towards a prostatic pathology. Metastasis to the bones could explain the pain in his back and hips. Frequency, urgency and terminal dribbling are features of prostate cancer. Black men are at greatest risk for prostate cancer. The most frequent sites of metastasis for prostate carcinoma are bone and lymph nodes of the obturator fossae, internal, external and common iliac arteries, and presacral regions.