28th February 2025

A 78-year-old gentleman presents to his GP with new dull, persistent ache in his pelvis

A 78-year-old gentleman presents to his GP with new dull, persistent ache in his pelvis and lower back and incomplete voiding over 6 months, which has gradually progressed. Prior to this he played golf once a week and was independent with activities of daily living. His past medical history includes allergic rhinitis and hypertension managed with ramipril.

The GP does a digital rectal examination, which shows an irregular prostate. X-ray of the hips and pelvis shows widespread sclerotic bony lesions. His PSA is 23. He is referred to urology on a two-week-wait pathway and is discussed in MDT. What is the most appropriate management option?

Select the SINGLE most appropriate option from the list below. Select ONE option only.