Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: no known allergies / adverse drug reactions attending: chief complaint: brbpr major surgical or invasive procedure: flexible sigmoidoscopy colonoscopy degarelix treatment red blood cell transfusions history of present illness: 76 y/om with pmh afib on coumadin, new onset rle swelling, and imaging suggestive on likely metastatic prostate ca who presented to the ed with brbpr. . patient complains of intermittent brbpr x 1 month which acutely worsened in the past several days to multiple frank bloody stools. no accompanying abdominal discomfort, fever or nausea/ vomiting. no history of gi bleed, but patient has a history of hemorrhoids and has never had a colonoscopy. two days prior to admission, after talking to his pcp, stopped taking coumadin. notes fatigue but denies any accompanying chest pain, sob, lightheadedness, or other complaints. . of note, this occurred in the setting of new onset lower extremity swelling with right > left. ct scan to further evaluate did not show any evidence of dvt but revealed large prostate mass with bulky lymphadenopathy causing hydronephrosis. although the patient was told that he probably has cancer, he does not know any further details of likely diagnosis. over the past several days to weeks, he notes increasing back pain similar to prior exacerbation of spinal stenosis. he denies any associated saddle anesthesia or bowel incontinence but does have worsening urinary retention. . in the ed, initial vs were: 97.8 112 150/100 20 100. labs were notable for hct of 34.7 from recent hct of 43.3 on , cr 1.3 (baseline 0.8) and inr of 2.9. patient typed and crossed, given 5mg vitamin k and 1 u ffp. ed course complicated by development of afib with hr in 150s and given metoprolol 25mg po x 2. admitted to the micu for further hemodynamic monitoring. past medical history: - epiglottitis - afib on coumadin - htn - tonsillectomy - seasonal allergies - spinal stenosis . social history: retired employee of and shipyard worker. lives with his wife - : former with 25 pack year history, quit 30yrs ago. - alcohol: drinls of scotch x weekly - illicits: denies family history: mother deceased of breast ca, no family hx of colorectal cancer physical exam: o: tc: 96.5 bp: 111/71 hr: 83 rr: 20 o2: 99%ra general: alert and oriented, appears well, nad heent: mmm, oropharynx clear, multiple psoriatic plaques on scalp and forehead lungs: clear to auscultation bilaterally, no wheezes, rales, ronchi cv: irregularly irregular, normal s1 + s2, no murmurs, rubs, gallops abdomen: soft, tender to palpation rlq at site of injection, erythema not spread beyond marked area. indurated, erythematous. non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly gu: 3+ scrotal/penile edema ext: +3 pitting edema in rle, +1 pe lle, wwp neurology: no focal deficits pertinent results: 06:00pm blood wbc-9.3 rbc-3.78* hgb-11.8*# hct-34.7* mcv-92 mch-31.3 mchc-34.0 rdw-14.7 plt ct-412# 01:23am blood hct-30.6* 06:00pm blood pt-29.2* ptt-29.5 inr(pt)-2.9* 01:23am blood pt-26.7* ptt-27.9 inr(pt)-2.6* 06:00pm blood glucose-95 urean-31* creat-1.3* na-142 k-3.8 cl-104 hco3-23 angap-19 06:31am blood glucose-106* urean-27* creat-1.1 na-143 k-4.0 cl-108 hco3-24 angap-15 06:00pm blood alt-19 ast-32 ld(ldh)-307* alkphos-72 totbili-0.3 06:31am blood calcium-8.1* phos-4.1 mg-1.6 03:49am blood testost-45* shbg-43 calcft-7.1* 06:00pm blood psa-1099* 06:50pm urine color-yellow appear-clear sp -1.013 06:50pm urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 03:29am urine hours-random creat-94 na-11 k-47 cl-17 colonoscopy findings: protruding lesions non-bleeding grade 1 internal hemorrhoids were noted. excavated lesions multiple diverticula were seen in the whole colon. impression: diverticulosis of the whole colon grade 1 internal hemorrhoids otherwise normal colonoscopy to cecum recommendations: diverticula and hemorrhoids noted. given two month hx of rectal bleeding consideration of related to hemorrhoidal bleeding. please return to for further recommendations. flexible sigmoidoscopy findings: contents: stool was found in the rectum and sigmoid colon. protruding lesions non-bleeding grade 1 internal hemorrhoids were noted. other mild scope trauma visualized in the rectum. no source of hematochezia identified. impression: stool in the rectum and sigmoid colon mild scope trauma visualized in the rectum. no source of hematochezia identified. grade 1 internal hemorrhoids otherwise normal sigmoidoscopy to sigmoid colon at 40 cm recommendations: prostate palpable and firm on rectal examination. limited study given stool but no active bleeding or lesion noted to 40 cm. recommend golytely prep for colonoscopy once stabilized. bone scan: interpretation: whole body images of the skeleton were obtained in anterior and posterior projections as well as spot images of the arms. there is increased uptake at approximately l3 on the right and l5 on the left; on the ct of there are degenerative changes in these locations which may account for these findings. the lumbar spine is partially obscured by activity in the ureters. there is increased uptake at approximately the 10th costovertebral junction on the right, likely degenerative. there are no other bony findings. there is increased soft tissue uptake which may relate to edema. the kidneys and urinary bladder are visualized, the normal route of tracer excretion. the ureters are displaced medially and have intense tracer activity. a catheter is in place. no previous studies for comparison. impression: uptake in approximately l3, l5, and the 10th costovertebral junction, all of which may be accounted for by degenerative change. no other bony findings ct abd/pelvis: 1. marked lymphadenopathy within the pelvis, with extension to abdominal lymph node chains as described above. there is associated bilateral hydronephrosis and hydroureter. findings are highly concerning for metastatic lymphadenopathy, and differential considerations include lymphoma and prostate carcinoma, given the enlarged and heterogeneous appearance of the prostate. 2. colonic diverticulosis. 3. trace bilateral pleural effusions. 4. no evidence of bowel obstruction, as questioned. kub: findings: a single supine portable view of the abdomen was obtained. there are many non-dilated gas-filled loops of jejunum and ileum, stacked on the left side of the abdomen. gas is seen within the rectum with little gas in the remainder of the colon. the pattern is concerning for early or partial obstruction. a high-density oval structure in the right lower quadrant is likely retained contrast in the cecum or barium in a giant cecal diverticulum. ct could be considered to evaluate if this is a cause of obstruction. gallstone ileus is unlikely given the lack of air in the biliary tree and the appearance of this density. retained contrast is seen in small scattered diverticula in the descending colon. impression: pattern concerning for early or partial obstruction, less likely gallstone ileus. obstruction might be caused by retained contrast in the cecum or a large cecal diverticulum. leni: findings: grayscale and doppler images of the right and left common femoral, right superficial femoral, right popliteal were obtained. there was normal compressibility, wall-to-wall flow with normal response to augmentation throughout. the calf veins were not definitely seen. subcutaneous edema is noted along the calf. impression: no dvt in right lower extremity. ekg : atrial fibrillation with rapid ventricular response. borderline low limb lead voltage. leftward axis. st-t wave abnormalities. since the previous tracing of the rate is faster : atrial fibrillation with a controlled ventricular response. low voltage in the limb leads. non-specific st-t wave abnormalities. compared to the previous tracing of there is no diagnostic change discharge labs: 06:40am blood wbc-4.8 rbc-3.28* hgb-9.8* hct-29.8* mcv-91 mch-29.9 mchc-32.9 rdw-14.7 plt ct-372 04:14pm blood hct-32.2* 07:13am blood pt-15.6* ptt-24.9 inr(pt)-1.4* 06:55am blood glucose-91 urean-17 creat-1.0 na-141 k-4.3 cl-106 hco3-29 angap-10 06:40am blood glucose-97 urean-21* creat-1.0 na-141 k-4.4 cl-106 hco3-29 angap-10 06:55am blood alt-21 ast-36 ld(ldh)-248 alkphos-71 totbili-0.9 07:40am blood calcium-8.7 phos-3.3 mg-1.6 brief hospital course: 76 y/om with pmh afib on coumadin, new onset rle swelling, and imaging suggestive on likely metastatic prostate ca who presented to the ed with bright red blood per rectum (brbpr), no active bleeding on colonoscopy, atrial fibrillation with rapid ventricular reponse (rvr) that was rate controlled, presumed metastatic colon cancer treated with degarelix, and urinary retention secondary to an enlarged prostate treated with a foley and tamsulosin. . # brbpr: required 3 blood transfusions while in the icu, initial flex sigmoidoscopy was negative for active bleeding. colonoscopy to cecum showed no active bleeding, but did reveal hemorrhoids and diverticulosis. patient did have 2 episodes of mild brbpr while on the floor with bowel movements thought to be secondary to hemorrhoids and straining with bowel movements. started on bowel regimen including colace, fiber, and senna prn. . # atrial fibrillation with rvr: initially elevated hr to 160s, treated with fluids and esmolol drip in icu. weaned to home medications of metoprolol and diltiazem. patient was tachycardic with ambulation so metoprolol was increased to 75mg tid. . # urinary retention: initial attempt at foley insertion was unsuccessful and caused bleeding from urethral meatus. urology consulted and inserted coude catheter. foley was removed 3 days prior to d/c, however patient was having frequent small voids thought to be overflow. a post void bladder scan revealed 950cc of urine so urology replaced foley. dishcarged with foley in place and started on tamsulosin with urology follow-up. . # presumed metastatic prostate cancer: ct scan in showing enlarged prostatic mass, bulky lymphadenopathy obscuring neurovasculature (likely cause of rle edema), and likely liver mets. oncology was consulted and recommended degarelix which patient received while in house. radiation-oncology was consulted and felt no acute intervention was needed. a bone scan was done which showed no bony lesions. . # psoriasis - did flare while in hospital, but resolved once patient applied home steroid ointment. medications on admission: - asa 81mg - diltiazem 60mg tid - metoprolol 50mg tid - warfarin 5mg daily - lasix 20mg daily - potassium chloride 10mg daily - topicort ointment discharge medications: 1. diltiazem hcl 60 mg tablet sig: one (1) tablet po three times a day. 2. lasix 20 mg tablet sig: one (1) tablet po once a day. 3. potassium chloride 10 meq capsule, sustained release sig: one (1) capsule, sustained release po once a day. 4. topicort topical 5. aspirin 81 mg tablet sig: one (1) tablet po once a day. 6. metoprolol tartrate 25 mg tablet sig: three (3) tablet po three times a day. disp:*270 tablet(s)* refills:*2* 7. tamsulosin 0.4 mg capsule, sust. release 24 hr sig: one (1) capsule, sust. release 24 hr po at bedtime. disp:*30 capsule, sust. release 24 hr(s)* refills:*0* discharge disposition: home discharge diagnosis: primary: gastrointestinal bleed, metastatic prostate cancer seoondary: hypertension, atrial fibrillation discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: dear mr. , it was a pleasure taking care of you during your hospitalization. you were admitted with bleeding from your rectum. you had a flexible sigmoidoscopy and a colonoscopy which showed no active source of bleeding. it was thought the bleeding is due to your hemorrhoids. we started you an a bowel regimen which should soften your stool and help you move your bowels without straining. you were seen by an oncologist and were treated with a medication, degarelix, that will help treat your cancer. we do not think that you need to be on coumadin for your atrial fibrillation as you are low risk for a stroke. you are going home with a foley as we did a post void bladder scan which showed 950cc of urine in your bladder. we added a medication, tamsulosin, that should help shrink the prostate and make it easier to urinate. you will follow up with the urologists in 1 week to help with the foley. we made the following changes to your medication: stopped coumadin increased metoprolol to 75mg tid started colace 100mg by mouth twice daily tamsulosin 0.4mg by mouth nightly please eat a high fiber diet, including adding metamucil, three times a day. you can add an over-the-counter medication, senna, to your regimen if you find you are still straining with your bowel movements. please follow up with your scheduled appointments. you can discuss with dr. regarding switching the metoprolol and diltiazem to long acting forms. followup instructions: oncology: dr. - oncology :00 am name: obli , md specialty: internal medicine when: tuesday at 12:40pm location: - address: , , phone: name: , pa specialty: urology when: tuesday at 11am location: address: , , phone: this appointment is with a physicians assistant. the attending physician for this appointment will be dr. . procedure: colonoscopy flexible sigmoidoscopy diagnoses: malignant neoplasm of liver, secondary unspecified essential hypertension acute posthemorrhagic anemia acute kidney failure, unspecified atrial fibrillation malignant neoplasm of prostate long-term (current) use of anticoagulants retention of urine, unspecified unspecified accident injury to bladder and urethra, without mention of open wound into cavity internal hemorrhoids with other complication hydronephrosis spinal stenosis, unspecified region other psoriasis diverticulosis of colon (without mention of hemorrhage) secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes edema 

Answer: The patient is high likely exposed to