He has lost significant weight and looks cachexic. What is the SINGLE most likely diagnosis?

A 79 year old African-Caribbean man comes in complaining of difficulty in passing urine. He has a weak stream, and says that he is unable to completely empty his bladder. 3 months ago he suffered from a urinary tract infection. He also complains of back pain and suprapubic pain. He has lost significant weight and looks cachexic. What is the SINGLE most likely diagnosis?

A. Benign prostatic hyperplasia
B. Renal cell carcinoma
C. Bladder stones
D. Prostate cancer
E. Urinary tract infection

Prostate carcinoma

Risk factors - Increasing age is the most important risk factor - Men of black African-Caribbean family origin - First-degree relative with prostate cancer

Presentation - Lower urinary tract symptoms (LUTS) do not particularly raise suspicion of prostate cancer because LUTS are common in older men and are rarely the presenting symptom of prostate cancer. However, locally advanced prostate cancer may cause obstructive LUTS

Local disease: - Raised PSA on screening

  • Weak stream, hesitancy, sensation of incomplete emptying, urinary frequency, urgency, urge incontinence - Urinary tract infection

Locally invasive disease: - Haematuria, dysuria, incontinence - Haematospermia - Perineal and suprapubic pain - Obstruction of ureters, causing loin pain, anuria, symptoms of acute kidney injury or chronic kidney disease

Metastatic disease: - Bone pain or sciatica - Paraplegia secondary to spinal cord compression - Lymph node enlargement - Lethargy (anaemia, uraemia) - Weight loss, cachexia