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: bilateral leg weakness major surgical or invasive procedure: 1. posterior thoracolumbar fusion with instrumentation and tumor debulking t3-l2 2. c6 corpectomy with acdf c4-7 3. c4-7 posterior decompression and fusion with instrumentation history of present illness: the pt is a 69m with a 1 week h/o progressive leg weakness who was found to have metastatic disease to his spine. this weakness occured after a one month h/o midline back pain with posterior leg numbness. he initially presented to ed where an mri showed a t11 compression fx with cord impingement as well as multi-level (cervical and thoracic) spinal cord masses with spinal cord narrowing and cord compression. of note he also passed blood clots in urine on the day prior to admission, but denies fecal incontinece. past medical history: - h/o back injury in - residual foot drop - cataracts - seasonal allergies - prostatic disease (difficulty urinating, but no h/o prostate exam, had enlarged prostate on mri in ) - elevated psa here social history: lives in with his wife. retired operating engineer at . 2 kids. non-smoker, occasional etoh. no other drugs. family history: father died of bladder cancer at age 82. mother died of dementia at age 89. sister with asthma. kids healthy. physical exam: vs: 98.2 115/67 84 20 98%ra general: well-appearing man wearing c-collar in nad, comfortable and appropriate. heent: nc/at, perrla, eomi, sclerae anicteric, mmm, op clear. neck: limited exam due to c-collar. heart: rrr, no mrg, nl s1-s2. lungs: cta bilat, no r/rh/wh, good air movement, resp unlabored. abdomen: soft, nontender, no rebound/guarding. extremities: wwp, no c/c/e, 2+ peripheral pulses. skin: large abrasion on anterior aspect of right calf with ecchymoses lymph: small right sided inguinal lymphadenopathy, none on left or in axilla. neuro: awake, a&ox3, cns ii-xii intact. 5/5 strength in rue except for triceps 4+/5 lue more weak compared to right with 4+/5 throughout. 3-/5 strength in ble flexors with inability to lift leg off the bed. some ability to dorsiflex right foot. reflexes symmetric but hyporeflexic in bue, hyporeflexic bilateral les. numbness in 1st and 2nd digits of left hand. also numbness on ble from thighs downward, with most notable numbness over medial aspect of left calf and lateral aspect of left thigh. pertinent results: 06:15am blood wbc-10.2 rbc-3.88* hgb-11.8* hct-34.1* mcv-88 mch-30.3 mchc-34.5 rdw-14.6 plt ct-272 06:00am blood wbc-8.9 rbc-4.00* hgb-11.9* hct-35.2* mcv-88 mch-29.6 mchc-33.7 rdw-14.8 plt ct-228 06:20am blood wbc-6.3 rbc-3.52* hgb-10.8* hct-31.1* mcv-88 mch-30.5 mchc-34.6 rdw-14.5 plt ct-211 05:20am blood wbc-6.2 rbc-3.17* hgb-9.9* hct-28.2* mcv-89 mch-31.2 mchc-35.1* rdw-14.6 plt ct-148* 02:51pm blood wbc-8.9 rbc-3.61* hgb-11.4* hct-31.1* mcv-86 mch-31.5 mchc-36.5* rdw-15.1 plt ct-123* 02:16am blood wbc-6.6 rbc-2.97* hgb-9.4* hct-24.9* mcv-84 mch-31.6 mchc-37.6* rdw-14.7 plt ct-102* 06:15am blood glucose-116* urean-17 creat-0.6 na-134 k-3.9 cl-96 hco3-29 angap-13 04:54pm blood glucose-114* urean-23* creat-0.7 na-138 k-4.3 cl-106 hco3-26 angap-10 05:20am blood glucose-90 urean-20 creat-0.7 na-140 k-3.9 cl-106 hco3-28 angap-10 02:12am blood glucose-114* urean-19 creat-0.7 na-144 k-3.7 cl-107 hco3-32 angap-9 06:00am blood calcium-8.2* phos-3.4 mg-1.9 02:52am blood calcium-8.4 phos-2.1* mg-1.9 02:16am blood calcium-8.9 phos-4.3# mg-2.3 ct c spine : 1. destructive lesion involving the c5, c6 vertebral bodies and posterior elements, with epidural extension at c6 level, causing mild spinal canal narrowing at that level. the above findings are concerning for metastatic disease. 2. no pathologic fracture is identified. note added in attending review: as on the virtually-concurrent (and technically adequate) enhanced mr is extensive replacement of the left lateral aspect of both the c5 and c6 vertebral bodies and their left and bilateral posterior elements, respectively, including the spinous processes and interspinous region. extensive associated parosseous soft tissue component completely occupies the left neural foramina at these levels, likely encroaching upon the exiting left c6, c7 and likely, c8 nerve roots. significanly better-demonstrated on the mr study is contiguous involvement of the left dorsolateral epidural space at the c6 level, with displacement and some compression of the spinal cord. finally, there is relatively well-defined luceny involving the left paramedian and central aspect of the base of dens and body of c2, with apparent focal cortical discontinuity, dorsally, but no pathologic fracture. however, there is no convincing signal or enhancement abnormality on the mr study to specifically confirm similar marrow replacement, and this may simply represent asymmetric fat. cxr : there is mild elevation of the left hemidiaphragm. otherwise normal lung volumes. no evidence of pleural effusions. borderline size of the cardiac silhouette. the lung parenchyma appears normal, there are no nodules or masses. the mediastinal contours appear unremarkable. the right hilus is minimally enlarged as compared to the left side. given the clinical presentation of the patient ct of the thorax should be considered. no evidence of osteodestructive lesions. mri c/t/l spine : multifocal bone destruction, presumably representing metastatic disease, as on the prompting very recent studies, most significantly including: 1. t7: marked destruction of this vertebral body with replacement and expansion of its posterior elements, in combination with substantial epidural soft tissue component, severely narrows the spinal canal, compressing the spinal cord which demonstrates faint t2 hyperintensity, likely representing edema. 2. t11: extensive bone destruction with central compression, but no significant angulation; slightly retropulsed dorsal cortex, in combination with epidural soft tissue, narrows the ventral canal with no frank cord compression or definite intrinsic signal abnormality. 3. c5-c6: extensive bone destruction, particularly on the left, with large paraosseous soft tissue mass significantly encroaching upon the left neural foramina and likely exiting neural impingement, as detailed above. there is also a component involving the left lateral and dorsal aspect of the spinal canal displacing and effacing the thecal sac. there is suggestion of slight t2-hyperintensity within the central cord substance which, again, may represent edema. 4. very small hydromyelic central canal of the spinal cord localized to the t5 level, which may relate to the severe compression at t7, as well as the presence of a focal disc herniation at the t3-4 level. brief hospital course: mr. was admitted to the spine surgery service on and taken to the operating room for thoracolumbar decompression and fusion t3-l3 the surgery was without complication and the patient was transferred to the pacu in a stable condition. teds/pnemoboots were used for postoperative dvt prophylaxis. intravenous antibiotics were given per standard protocol. initial postop pain was controlled with a pca. on hd#2 he returned to the operating room for a scheduled c6 corpectomy and anterior fusion c4-7. please refer to the dictated operative note for further details. the second surgery was also without complication and the patient was transferred to the pacu in a stable condition. postoperative hct was low and he was transfused multipe units of prbcs and platelets. he was kept npo until bowel function returned then diet was advanced as tolerated. the patient was transitioned to oral pain medication when tolerating po diet. he subsequently was taken back to the or for a scheduled c4-7 posterior decompression and fusion with instrumentatiion. foley remained in place and will be managed at rehab. he was fitted with a tlso brace. physical therapy was consulted for mobilization oob to ambulate. hospital course was otherwise unremarkable. on the day of discharge the patient was afebrile with stable vital signs, comfortable on oral pain control and tolerating a regular diet. medications on admission: - probiotics, ginko, saw , stinging nettle, bioflavanoid, vitamin b complex, vitamin c, calciu, magnesium, omega3 discharge medications: 1. bicalutamide 50 mg tablet sig: one (1) tablet po daily () as needed for metastatic prostate cancer for 30 days days. 2. senna 8.6 mg tablet sig: one (1) tablet po bid (2 times a day) as needed for constipation. 3. acetaminophen 325 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for fever, pain. 4. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. glucagon (human recombinant) 1 mg recon soln sig: one (1) recon soln injection q15min () as needed for hypoglycemia protocol. 7. heparin (porcine) 5,000 unit/ml solution sig: one (1) syringe injection (2 times a day). 8. diazepam 5 mg tablet sig: one (1) tablet po q6h (every 6 hours) as needed for spasm. 9. oxycodone 10 mg tablet extended release 12 hr sig: one (1) tablet extended release 12 hr po q12h (every 12 hours). 10. oxycodone-acetaminophen 5-325 mg tablet sig: 1-2 tablets po q4h (every 4 hours) as needed for pain. discharge disposition: extended care facility: nursing & therapy center - ( rehabilitation and nursing center) discharge diagnosis: metastic ca with tumor masses t7, t9 and c6 prostate ca acute post-op blood loss anemia discharge condition: good discharge instructions: you have undergone the following operation: 1. posterior thoracolumbar fusion with instrumentation and tumor debulking t3-l2 2. c6 corpectomy with acdf c4-7 3. c4-7 posterior decompression and fusion with instrumentation immediately after the operation: -activity: you should not lift anything greater than 10 lbs for 2 weeks. you will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. -rehabilitation/ physical therapy: o2-3 times a day you should go for a walk for 15-30 minutes as part of your recovery. you can walk as much as you can tolerate. olimit any kind of lifting. -diet: eat a normal healthy diet. you may have some constipation after surgery. you have been given medication to help with this issue. -brace: you have been given a brace. this brace is to be worn for comfort when you are walking. you may take it off when sitting in a chair or while lying in bed. -wound care: remove the dressing in 2 days. if the incision is draining cover it with a new sterile dressing. if it is dry then you can leave the incision open to the air. once the incision is completely dry (usually 2-3 days after the operation) you may take a shower. do not soak the incision in a bath or pool. if the incision starts draining at anytime after surgery, do not get the incision wet. cover it with a sterile dressing. call the office. -you should resume taking your normal home medications. no nsaids. -you have also been given additional medications to control your pain. please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. you can either have them mailed to your home or pick them up at the clinic located on 2. we are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. in addition, we are only allowed to write for pain medications for 90 days from the date of surgery. please call the office if you have a fever>101.5 degrees fahrenheit and/or drainage from your wound. physical therapy: activity: activity: out of bed w/ assist thoracic lumbar spine: when oob cervical collar: when oob treatments frequency: please continue to inspect the incisions daily. followup instructions: with dr. in 10 days. call for an appointment. procedure: other excision of joint, other specified sites other excision of joint, other specified sites other cervical fusion of the anterior column, anterior technique excision of bone for graft, other bones dorsal and dorsolumbar fusion of the posterior column, posterior technique repair of vertebral fracture other cervical fusion of the posterior column, posterior technique insertion of interbody spinal fusion device fusion or refusion of 2-3 vertebrae fusion or refusion of 2-3 vertebrae fusion or refusion of 9 or more vertebrae insertion of recombinant bone morphogenetic protein diagnoses: acute posthemorrhagic anemia hemorrhage complicating a procedure malignant neoplasm of prostate gross hematuria secondary malignant neoplasm of bone and bone marrow paraplegia secondary malignant neoplasm of other parts of nervous system other acquired deformities of ankle and foot myelopathy in other diseases classified elsewhere pathologic fracture of vertebrae salicylates causing adverse effects in therapeutic use vascular myelopathies slowing of urinary stream 

Answer: The patient is high likely exposed to