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70-year-old man with history of benign prostatic hypertrophy (BPH) and urinary retention, has recent history of soreness in groin, low back pain and weight loss. DRE: Normal rectal tone. Enlarged nodular prostate with minimal induration.
Bone scan: Generalized whole body skeletal metastases. Hip knee and ankle: Extensive bone mets in entire pelvis, right and left proximal femurs. Chest: Patchy areas of asbestos-like scarring, consistent with prior films.
PSA level 120 (0-4.0 ng/ml)
Cystoscopy: Bladder was without masses or stones.
TURP: Resection included significant tissue from the anterior lobe of the prostate.
TURP: Prostate chips - Adenocarcinoma, prostate. Moderately to poorly differentiated, Gleason's score 5+5=10. Carcinoma involves every fragment.
Orchiectomy: R and L testis: no tumor identified.
Surgery: Transurethral resection of prostate (TURP).
Hormone: Bilateral simple orchiectomy