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Bladder cancer suspected haematuria — MCCQE Part 1 MCQ

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ModerateBlood in UrineBladder cancer suspected haematuriaMCCQE Part 1

A 66-year-old man with a 40-pack-year smoking history has painless visible haematuria on two occasions. Urine culture is negative and he has no dysuria. Which of the following is the most appropriate next step?

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Correct answer: C — Refer for urologic evaluation including cystoscopy and upper-tract imaging

Painless gross haematuria in an older smoker is bladder cancer until proven otherwise and requires cystoscopy and upper-tract evaluation. Negative culture makes infection less likely, and PSA does not assess the bladder mucosa. Reassurance or prolonged empiric antibiotics delays cancer diagnosis.

Reference: Canadian Urological Association haematuria guidance; provincial haematuria pathways