A 68-year-old male presents to his primary care provider with complaints of difficulty urinating, a weak urinary stream, and increased frequency, especially at night, for the past 6 months. He also reports feeling a sense of incomplete bladder emptying and occasionally notices blood in his urine. He denies pain or burning during urination but mentions having mild lower back pain over the past few weeks.

The patient has a history of hypertension and hyperlipidemia, which are well-controlled with medication. He has no significant family history of prostate cancer but has a history of benign prostatic hyperplasia (BPH). He is a former smoker, having quit 10 years ago, and has a moderate alcohol consumption.

On physical examination, the patient is well-nourished and in no acute distress. Abdominal examination is unremarkable. A digital rectal exam (DRE) reveals a firm, non-tender, irregularly enlarged prostate. No lymphadenopathy or hepatomegaly is noted. A urine analysis shows microscopic hematuria, and a prostate-specific antigen (PSA) level is significantly elevated at 12 ng/mL (normal range: 0-4 ng/mL).

Given the patient's symptoms, DRE findings, and elevated PSA, a transrectal ultrasound (TRUS) guided biopsy of the prostate is performed, which confirms the presence of prostate adenocarcinoma. The cancer is staged as localized, and the patient is referred to an oncologist for further management. Options for treatment include radical prostatectomy, radiation therapy, or active surveillance, depending on the patient's preferences and overall health.