A 68-year-old retired chef initially complained of frequency of micturition, urinary urgency, and hesitancy associated with a weak stream. Over the past several weeks, he has reported a few episodes of hematuria and incontinence. In addition to his urologic symptoms, the patient complained of low-grade, constant back pain and bouts of constipation. A digital rectal examination revealed the patient has an enlarged prostate gland with several palpably discrete nodules.
His past medical history was unremarkable. Laboratory Studies The patient had a prostate-specific antigen (PSA) level of 95 ng/mL (range: 0.0–4.0 ng/mL), while a similar determination 6 years earlier showed a PSA of 1.5 ng/mL. His hemoglobin was 15 g/dL (range: 13.2–17.1 g/dL), hematocrit 43% (range: 38.5–50%), white blood cell 7,500/mm3, normal differential, platelets 250,000/mm3, blood urea nitrogen 15 mg/dL (normal…
