A man aged, 78 years was presented with low back pain. He had metastatic prostate cancer, which was diagnosed 2 years ago, and a solitary asymptomatic bone metastasis in the right pubic bone. To date, he had been managed with androgen deprivation therapy (goserelin) alone. His performance status was good and his prostate-specific antigen (PSA) level stable. Past medical history His past medical history included hyperlipidaemia and atrial fibrillation. He was on atorvastatin and warfarin.
He had no known allergies, was a non-smoker and did not drink alcohol. He reported a 6-week history of constant, burning pain in the lower lumbar region, which was worse at night and was 7/10 in severity on the Numeric Pain Rating Scale. He had no relief with regular paracetamol or ibuprofen. He had not had lower limb weakness, numbness, lower urinary tract symptoms or weight loss. Physical examination…
