Prostate cancer Quiz: Ace Your Exams

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A 70-year-old man comes to the office because of progressive lower back pain. He first noticed the pain a few months ago at the grocery store. It is most severe at night and is not relieved by rest, exercise, medication or change in position. He has not had any recent trauma. He also reports difficulty initiating urination and dysuria for the past 6 months. He is a retired veteran and lives alone. Past medical history is noncontributory. Family history is significant for colorectal cancer in his father. Vitals are within normal limits. Neurological examination and straight leg raise test are normal. MRI of the lumbar spine is performed and shown below:  


Reproduced from: Radiopaedia  

Further evaluation of this patient will most likely show which of the following?  

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Choose an option: