E.S. is a 71 year old African American male with:
Past Medical History
- Hypertension
- Hyperlipidemia
- Obesity
- Type II Diabetes
Social History
- Drinks approximately five 12 oz. beers each night before bed
Familial history
- Paternal grandmother breast cancer
- Father prostate cancer
Vital Signs:
- Oral temperature 98.6
- Respiratory rate 18
- Heart rate 86
- Blood pressure 150/86
- O2 saturation 95%
Labs:
- PSA level: 75 ng/mL
E.S. presents to your primary care clinic with worsening lower back pain over the last few months. He also complains that he has been experiencing frequency, urgency, and hesitancy while urinating. When asking E.S. about his symptoms, he claims that he just can’t seem to “get it all out.” He denies pain when urinating, but says sometimes his urine looks pink. His wife also mentions that he has been getting up to use the restroom 2-3 times each night and it is very disruptive to their sleep. When asking when his initial symptoms began, E.S. states that his lower back pain and urinary symptoms started “months ago,” but he thought “he was just getting old” and did not feel the need to get it checked out. Due to his unremitting lower back pain and urinary symptoms, he went to an urgent care facility about a month ago where he was prescribed oral antibiotics for a UTI. Despite finishing his prescribed antibiotics, his symptoms persisted and have even worsened. His wife also states that she, “gave him some of her leftover antibiotics that were prescribed to her from a previous UTI, but it still didn’t seem to help.” E.S. and his wife are hoping to get a second opinion. What’s going on with E.S.?