Prostate Disorders – High-Yield MCQs with Explanations for MSRA

1. A 55-year-old man requests a PSA test during a telephone consultation. He is asymptomatic. What is the most appropriate next step?

Choose the correct answer

• A. Arrange PSA test immediately.
• B. Book him for a face-to-face appointment and prostate exam
• C. Advise PSA testing is not available in primary care
• D. Refer him urgently to urology

Answer: B. Book him for a face-to-face appointment and prostate examination.

 🔑 Explanation: PCRMP requires counselling + DRE before PSA testing.

2. Which of the following does NOT cause a significant rise in PSA?

Choose the correct answer

• A. Recent ejaculation
• B. Urinary retention
• C. Vigorous exercise
• D. Digital rectal examination (DRE)

Answer: D. Digital rectal examination (DRE)

 🔑 Explanation: DRE causes minimal, clinically insignificant rise.

3. Which of the following statements about PSA testing is TRUE?

Choose the correct answer

• A. A normal PSA completely rules out prostate cancer.
• B. PSA testing is part of the national screening programme
• C. PSA can be raised in prostatitis and BPH
• D. PSA is specific for prostate cancer

Answer: C. PSA can be raised in prostatitis and BPH. 

🔑 Explanation: PSA is prostate-specific but not cancer-specific.

4. A 65-year-old man has a PSA level of 6.5 ng/mL. He is asymptomatic. What is the next step?

Choose the correct answer

• A. Repeat PSA in 6 months.
• B. Urgent 2WW referral to urology
• C. Treat with antibiotics and repeat PSA
• D. Reassure as it is normal for age

Answer: B. Urgent 2WW referral.

 🔑 Explanation: Age-specific cutoff for 60–69 is up to 4.0 ng/mL.

5. Which genetic mutation increases the risk of prostate cancer?

Choose the correct answer

• A. BRCA1
• B. BRCA2
• C. APC
• D. RET

Answer: B. BRCA2

 🔑 Explanation: BRCA2 significantly increases prostate cancer risk.

6. A 65-year-old man presents with nocturia, hesitancy, and a weak urinary stream. DRE shows a smooth, enlarged prostate. PSA is normal. What is the first-line treatment?

Choose the correct answer

• A. Finasteride
• B. Tamsulosin
• C. TURP
• D. Watchful waiting

Answer: B. Tamsulosin 

🔑 First-line for moderate BPH symptoms is an α1-blocker (e.g. tamsulosin) for rapid symptom relief. 

7. A 55-year-old man on finasteride has a PSA of 2 ng/mL. What is the interpreted PSA value?

Choose the correct answer

• A. 1 ng/mL
• B. 2 ng/mL
• C. 3 ng/mL
• D. 4 ng/mL

Answer: D. 4 ng/mL

🔑 Finasteride reduces PSA by ~50%. Multiply by 2 for true interpretation. 

8. Which of the following factors does NOT increase PSA levels?

Choose the correct answer

• A. Ejaculation
• B. Vigorous cycling
• C. Smoking
• D. Digital rectal examination

Answer: C. Smoking 

 🔑 Smoking does not directly affect PSA though it increases general cancer risk.

9. Which prostate pathology is associated with a boggy, tender prostate on examination?

Choose the correct answer

• A. BPH
• B. Prostate cancer
• C. Chronic prostatitis
• D. Acute prostatitis

Answer: D. Acute prostatitis 

 🔑 Presents with fever, LUTS pain, boggy tender prostate, requires urgent antibiotics.

10.  A 68-year-old man presents with back pain, weight loss, and lethargy. PSA is 2 ng/mL. What is the next best step?

Choose the correct answer

• A. Reassure
• B. Repeat PSA in 6 months
• C. Urgent urology referral 
• D. Start finasteride

Answer: C. Urgent urology referral

🔑 Red flags (bone pain, weight loss) warrant urgent referral, even with normal PSA. 

11. A man with chronic prostatitis has persistent perineal pain despite antibiotics. What adjunct treatment is recommended?

Choose the correct answer

• A. TURP
• B. CBT
• C. Finasteride
• D. Radiotherapy

 Answer: B. CBT 

🔑 Cognitive behavioural therapy helps manage chronic pain and health anxiety.

12. Which of the following is a side effect of tamsulosin?

Choose the correct answer

• A. Gynaecomastia
• B. Retrograde ejaculation
• C. Dry mouth
• D. Constipation

Answer: B. Retrograde ejaculation 

 🔑 Due to α1A blockade at bladder neck.

13. Which drug class reduces prostate size over months in BPH?

Choose the correct answer

• A. Alpha blockers
• B. 5-alpha reductase inhibitors
• C. Antimuscarinics
• D. Beta blockers

Answer: B. 5-alpha reductase inhibitors 

 🔑 Finasteride/dutasteride reduce prostate size by lowering DHT.

14.  A man presents with fever, dysuria, and perineal pain. DRE reveals a boggy tender prostate. What is the next step?

Choose the correct answer

• A. Start tamsulosin
• B. Prostate massage
• C. Start ciprofloxacin and admit if septic
• D. Reassure and review

Answer: C. Start ciprofloxacin and admit if septic

🔑 Acute prostatitis requires urgent antibiotics; avoid prostatic massage. 

15. A patient has LUTS with a PSA of 2.8 ng/mL. No red flags. Next step?

Choose the correct answer

• A. Urgent referral
• B. Routine referral
• C. Start α-blocker in primary care
• D. Start finasteride in primary care

Answer: C. Start α-blocker in primary care 

 🔑 PSA < 3 ng/mL, no red flags → treat LUTS in primary care with α-blocker.

16. What is the mechanism of action of tamsulosin?

Choose the correct answer

• A. Inhibits 5-alpha reductase
• B. Selective α1A adrenergic antagonist 
• C. β3 agonist
• D. Muscarinic antagonist

Answer: B. Selective α1A adrenergic antagonist 

 🔑 Relaxes prostate and bladder neck smooth muscle, improving urine flow.

17. Which of the following drugs is NOT used in BPH management?

Choose the correct answer

• A. Tamsulosin
• B. Finasteride
• C. Doxazosin
• D. Oxybutynin

 Answer: D. Oxybutynin 

🔑 Oxybutynin is an antimuscarinic used in overactive bladder, not for BPH itself.

18. A 60-year-old man asks about prostate screening. What is the NHS approach?

Choose the correct answer

• A. Routine PSA for all men ≥50
• B. PSA only if symptomatic
• C. No PSA testing in primary care
• D. PSA offered after discussing risks/benefits (PCRMP)

Answer: D. PSA offered after discussing risks/benefits (PCRMP) 

 🔑 Prostate Cancer Risk Management Programme (PCRMP) guides GPs to offer PSA after informed discussion, no national screening programme exists.

19. What is the classic pathology of prostate cancer metastases to bone?

Choose the correct answer

• A. Lytic lesions
• B. Sclerotic (osteoblastic) lesions
• C. Mixed lytic-sclerotic lesions
• D. No bone metastases

Answer: B. Sclerotic (osteoblastic) lesions

🔑 Prostate cancer causes osteoblastic bone metastases, leading to sclerosis on imaging. 

20.  Which of the following is NOT an effect of finasteride?

Choose the correct answer

• A. Reduces prostate volume
• B. Lowers DHT levels
• C. Rapid symptom relief within days 
• D. Lowers PSA by ~50%

Answer: C. Rapid symptom relief within days

 🔑 Finasteride takes months to show effect; α-blockers give rapid symptom relief.

21. A patient with BPH on tamsulosin develops dizziness and postural hypotension. What is the cause?

Choose the correct answer

• A. α1B receptor blockade in vasculature
• B. α1A receptor blockade in prostate
• C. β1 receptor blockade in heart
• D. β2 receptor blockade in bronchi

Answer: A. α1B receptor blockade in vasculature

 🔑 Though tamsulosin is relatively α1A-selective, it can still have some α1B blockade → vasodilation → hypotension.

22. Which prostate condition is most likely if PSA is normal, DRE is smooth and tender, and there is perineal pain for >3 months?

Choose the correct answer

• A. Acute prostatitis
• B. Chronic prostatitis (CP/CPPS)
• C. BPH
• D. Prostate cancer

Answer: B. Chronic prostatitis (CP/CPPS) 

 🔑 Chronic pelvic pain syndrome (CPPS): perineal pain ≥ 3 months, normal PSA, tender prostate.

23. A 72-year-old man presents with LUTS. DRE shows a hard, nodular prostate. PSA is 5 ng/mL. What is the most appropriate next step?

Choose the correct answer

• A. Start tamsulosin
• B. Reassure and review in 6 months
• C. Urgent 2-week-wait referral to urology
• D. Start finasteride

Answer: C. Urgent 2-week-wait referral to urology 

 🔑 Hard/nodular prostate = cancer until proven otherwise, regardless of PSA value.