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27th June 2023
A 78-year-old man presents to his GP with hip and back pain. He has also recently noticed worsening symptoms
A 78-year-old man presents to his GP with hip and back pain. He has also recently noticed worsening symptoms of dysuria, hesitancy and dribbling when he tries to pass urine. Occasionally he has noticed blood-tinged urine. Other medication includes ramipril for hypertension. On examination, his BP is 139/87 mmHg, pulse is 78 bpm, and PR examination reveals a firm, enlarged prostate with obliteration of the lateral sulcus. Bloods show:
| Hb | 107 g/L | (115-155 g/L) |
| WBC | 7.8 x 10⁹/L | (4.0-11.0 x 10⁹/L) |
| Platelets | 210 x 10⁹/L | (150-500 x 10⁹/L) |
| Neutrophils | 0.2 x 10⁹/L | (2.5-7.58 x 10⁹/L) |
| Sodium | 137 mmol/L | (135-145 mmol/L) |
| Potassium | 5.6 mmol/L | (3.5-5.0 mmol/L) |
| Alkaline Phosphatase | 2980 IU/L | (30-139IU/L) |
| Alanine Aminotransferase | 32 IU/L | (5-30 IU/L) |
| Creatinine | 195 μmol/L | (50-120 μmol/L) |
| Corrected calcium | 2.4 mmol/L | (2.20-2.60 mmol/L) |
| PSA | 2.9 ng/ml | <5ng/ml |
Which of the following investigations is most likely to reveal the underlying pathology?
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