Prostate

Question 1

What are three common lower urinary tract symptoms (LUTS) of BPH?

Answer 1

• Urinary hesitancy
• Weak urinary stream
• Nocturia
• Urinary frequency
• Incomplete bladder emptying
• Post-void dribbling

These symptoms are often experienced by patients with benign prostatic hyperplasia.

Question 2

Name three obstructive urinary symptoms seen in BPH.

Answer 2

• Weak stream
• Hesitancy
• Intermittency
• Straining to void
• Incomplete emptying

Obstructive symptoms are related to difficulty in urination due to prostate enlargement.

Question 3

Name three irritative urinary symptoms seen in BPH.

Answer 3

• Urinary frequency
• Urgency
• Nocturia

Irritative symptoms are characterized by increased urgency and frequency of urination.

Question 4

Name three complications of untreated BPH.

Answer 4

• Acute urinary retention
• Recurrent UTIs
• Bladder stones
• Hydronephrosis
• Renal insufficiency

These complications can arise if BPH is not managed appropriately.

Question 5

Name three components of the initial evaluation of suspected BPH.

Answer 5

• Focused urinary symptom history (LUTS)
• Digital rectal exam
• Urinalysis
• PSA testing (when appropriate)
• Symptom scoring (IPSS)

A thorough evaluation is essential for diagnosing BPH.

Question 6

What findings on digital rectal exam suggest benign prostatic hyperplasia?

Answer 6

• Enlarged prostate
• Smooth surface
• Symmetric enlargement
• Rubbery consistency

These findings typically indicate BPH rather than prostate cancer.

Question 7

What findings on digital rectal exam raise concern for prostate cancer?

Answer 7

• Hard nodules
• Asymmetric prostate
• Firm irregular areas
• Induration

These findings may indicate malignancy and warrant further investigation.

Question 8

Name three medications that can worsen urinary retention in patients with BPH.

Answer 8

• Anticholinergics (e.g., oxybutynin)
• Antihistamines
• Decongestants (pseudoephedrine)
• Tricyclic antidepressants
• Opioids

These medications can exacerbate urinary retention symptoms.

Question 9

What is the first-line pharmacologic treatment for symptomatic BPH?

Answer 9

• Alpha-1 blockers (e.g., tamsulosin, alfuzosin, doxazosin, terazosin)

Alpha-1 blockers help relax the muscles in the prostate and bladder neck.

Question 10

Name three common side effects of alpha-1 blockers used for BPH.

Answer 10

• Orthostatic hypotension
• Dizziness
• Ejaculatory dysfunction
• Fatigue
• Nasal congestion

These side effects are important to consider when prescribing these medications.

Question 11

Name two 5-alpha reductase inhibitors used for BPH.

Answer 11

• Finasteride
• Dutasteride

These medications are used to reduce prostate size and improve urinary symptoms.

Question 12

Name two clinical situations where a 5-alpha reductase inhibitor is preferred for BPH.

Answer 12

• Large prostate (>30–40 mL)
• Elevated PSA suggesting larger prostate volume
• Moderate-to-severe symptoms with prostate enlargement

These situations indicate a higher likelihood of benefit from 5-alpha reductase inhibitors.

Question 13

How do 5-alpha reductase inhibitors affect PSA levels?

Answer 13

• Reduce PSA levels by approximately 50% after 6 months

This reduction is important for monitoring prostate health.

Question 14

Name two common side effects of 5-alpha reductase inhibitors.

Answer 14

• Decreased libido
• Erectile dysfunction
• Ejaculatory dysfunction
• Gynecomastia

These side effects can impact patient adherence to treatment.

Question 15

Name three indications for urology referral in patients with BPH.

Answer 15

• Recurrent urinary retention
• Recurrent UTIs
• Hematuria
• Bladder stones
• Renal impairment
• Failure of medical therapy

Referral may be necessary for more advanced management.

Question 16

What is the definitive surgical treatment for severe BPH?

Answer 16

• Transurethral resection of the prostate (TURP)

TURP is often considered when medical management fails.

Question 17

A 68-year-old man presents with urinary hesitancy, weak stream, and nocturia. DRE shows a smooth enlarged prostate. What is the most appropriate first pharmacologic treatment?

Answer 17

• Alpha-1 blocker (e.g., tamsulosin)

This treatment is effective for managing symptoms of BPH.

Question 18

A 72-year-old man with BPH develops sudden inability to urinate and suprapubic discomfort. What is the immediate management?

Answer 18

• Insert a Foley catheter to relieve acute urinary retention

This is a critical step in managing acute urinary retention.

Question 19

Name three risk factors for prostate cancer.

Answer 19

• Age >50
• Family history of prostate cancer
• African ancestry
• BRCA mutations

These factors increase the likelihood of developing prostate cancer.

Question 20

Name three possible symptoms of advanced prostate cancer.

Answer 20

• Bone pain (especially spine/pelvis)
• Weight loss
• Hematuria
• Urinary obstruction

These symptoms may indicate progression of the disease.

Question 21

Name three investigations used when prostate cancer is suspected.

Answer 21

• PSA test
• Digital rectal exam
• Prostate MRI
• Transrectal prostate biopsy

These investigations help confirm the diagnosis of prostate cancer.

Question 22

Name three common sites of metastasis for prostate cancer.

Answer 22

• Bone (most common)
• Lymph nodes
• Liver
• Lung

Understanding metastasis is crucial for managing advanced prostate cancer.

Question 23

Name three symptoms of acute bacterial prostatitis.

Answer 23

• Fever
• Dysuria
• Perineal pain
• Urinary retention
• Tender prostate on DRE

These symptoms are indicative of acute bacterial infection of the prostate.

Question 24

Name two antibiotics commonly used to treat acute bacterial prostatitis.

Answer 24

• Ciprofloxacin
• Trimethoprim-sulfamethoxazole

These antibiotics are effective in treating bacterial prostatitis.