MCQs on Prostate – AMC Wise

Written by Dr. Daniel Fraser (MBBS, FRACP) – Physician

Question 1

James, a 68-year-old man, visits your clinic with complaints of increased urinary frequency, nocturia, a weak urinary stream, and a sensation of incomplete bladder emptying for the past 6 months. He denies dysuria or hematuria. On digital rectal examination, the prostate is enlarged, smooth, and non-tender. His urinalysis is normal, and serum PSA is 2.5 ng/mL.

Which of the following is the most appropriate initial management?

A) Transurethral resection of the prostate (TURP)
B) Start tamsulosin therapy
C) Start finasteride therapy
D) Refer for prostate biopsy
E) Begin empirical antibiotic treatment

Which of the following is the most appropriate initial management?

A) Transurethral resection of the prostate (TURP)
B) Start tamsulosin therapy
C) Start finasteride therapy
D) Refer for prostate biopsy
E) Begin empirical antibiotic treatment

Question 2

Daniel, a 56-year-old man, presents to the emergency department with acute onset of fever, chills, perineal pain, and dysuria. He reports urinary frequency and urgency over the last 24 hours. On examination, he appears unwell and febrile at 38.6°C. Digital rectal examination reveals a tender, swollen, and warm prostate. Urinalysis shows pyuria and bacteriuria.

What is the most appropriate initial management?

A) Immediate prostate massage to aid diagnosis
B) Oral ciprofloxacin and outpatient follow-up
C) Admit for intravenous antibiotics and supportive care
D) Transrectal prostate biopsy
E) Schedule transurethral resection of the prostate (TURP)

Correct Answer: C) Admit for intravenous antibiotics and supportive care

Explanation:
Daniel has acute bacterial prostatitis, a urological emergency. The presence of fever, systemic symptoms, and a tender prostate on DRE strongly supports this diagnosis. Initial management includes hospital admission for intravenous broad-spectrum antibiotics (e.g., IV fluoroquinolones or third-generation cephalosporins) and supportive care, including hydration and analgesia.

Why other options are incorrect:

A) Prostate massage is contraindicated in acute prostatitis as it may cause bacteremia or sepsis.
B) Oral antibiotics may be used in mild cases, but this patient has systemic signs and needs IV therapy.
D) Prostate biopsy is not needed for diagnosis and is unsafe during acute infection.
E) TURP is not indicated acutely; it’s used in chronic retention or failure of medical management in BPH.

Question 3

Mark, a 40-year-old man, visits your clinic complaining of perineal discomfort, pain during ejaculation, and urinary hesitancy for the past 3 months. He has had multiple urine cultures, all negative. His physical examination is unremarkable except for mild tenderness on digital rectal exam. His symptoms fluctuate but never fully resolve. He has no fever, chills, or history of urinary tract infections.

Which of the following is the most likely diagnosis?

A) Chronic bacterial prostatitis
B) Chronic pelvic pain syndrome (chronic prostatitis)
C) Benign prostatic hyperplasia (BPH)
D) Urethral stricture
E) Acute bacterial prostatitis

Correct Answer: B) Chronic pelvic pain syndrome (chronic prostatitis)

Explanation:
Mark’s presentation is typical of chronic pelvic pain syndrome (CPPS), also known as chronic non-bacterial prostatitis. This condition is characterized by chronic pelvic or perineal pain, often associated with lower urinary tract symptoms, painful ejaculation, and negative urine cultures. It is the most common form of prostatitis and is often a diagnosis of exclusion.

Why other options are incorrect:

A) Chronic bacterial prostatitis typically presents with recurrent UTIs and positive urine cultures, which are absent here.
C) BPH is uncommon at this age and is associated more with urinary symptoms than pain.
D) Urethral stricture could explain some urinary symptoms but not ejaculatory pain or perineal discomfort.
E) Acute prostatitis would present more dramatically with fever, chills, and a very tender prostate, none of which are present.

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4. Nephrology & Urology Module

4.1 Hematuria

4.2 Chronic Kidney Disease

4.3 Urinary Incontinence

4.4 Prostate

4.5 Renal Tumors

4.6 Other Renal Disorders

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