Something didn’t seem right though. I remember going home that night and being bothered by the case. The patient was a bit gaunt and was reporting some weight loss and back pain, but I couldn’t put my finger on what was bothering me.
Three days later when he came into the office, the RUG/voiding cystogram showed a stricture, but it wasn’t in the bulbar urethra. It seemed more proximal, almost prostatic. I wasn’t sure exactly what was going on at that point, so I did a rectal exam.
I remember walking out of the room immediately after the rectal exam after telling the patient that I would give him a chance to clean up and nearly vomiting. The rectal exam was evil, revealing one of those rock-hard prostates with obliterated edges. It was the prostate of an 80-year-old man with a five-digit PSA. I ordered a stat CT that showed a huge mass in the pelvis (either prostatic or bladder) with multiple lung masses and evidence of metastases everywhere. Biopsy of the lesion showed rhabdomyosarcoma. He went to the big children’s hospital nearby and expired of complications related to chemotherapy a month later.