A 63-year-old Black man presents with back pain, blood in his urine, and urinary frequency with difficulty in completely voiding his bladder. He reports a loss of appetite in the past 3 months as well as an unintentional 10-lb weight loss. He also reports occasional urinary incontinence and pain in his hips and right leg.

Physical exam reveals edema in the lower extremities and a slight gait disturbance. The patient appears tired and pale. There is lymphadenopathy in the inguinal and cervical nodes. There is abdominal bloating and tenderness on palpation as well as slight hepatomegaly. Digital rectal exam (DRE) shows bilateral hard, fixed, and enlarged lobes of the prostate. Laboratory tests are performed and show a prostate-specific antigen (PSA) level of 3000 ng/mL and a serum creatinine level of 1.3 mg/dL. Urinalysis confirms hematuria and shows a moderate leukocyte level (100 cacells/µL).

The patient has a history of hypertension and hyperlipidemia, both which are pharmacologically well managed. He has a negative history of any type of cancer but a maternal history of breast cancer.