A 64-Year-Old Man Comes to the Office Due to Several

A 64-year-old man comes to the office due to several episodes of intermittent hematuria over the past 2 months.  He has had no abdominal pain, burning on urination, or fever but has lost 4.5 kg (10 lb) since the onset of symptoms.  The patient has smoked a pack of cigarettes daily for 30 years.  Vital signs are within normal limits.  The abdomen is soft, nontender, and nondistended.  An enlarged and firm prostate is palpated on digital rectal examination.  Serum calcium is 12.3 mg/dL.  Urinalysis shows 30-40 red blood cells/hpf, negative protein, and no casts.  A CT scan of the abdomen is shown below. Which of the following is the most likely diagnosis?

A) Bladder cancer
B) Pheochromocytoma
C) Polycystic kidney disease
D) Prostate cancer
E) Renal cell carcinoma
F) Ureterolithiasis

Correct Answer:

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