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Benign prostatic hyperplasia — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareBenign prostatic hyperplasiaUSMLE Step 3

A 67-year-old has bothersome lower urinary tract symptoms, prostate volume 58 mL, PSA 2.4 ng/mL, and postvoid residual 70 mL. He wants both prompt symptom relief and lower long-term risk of retention. Which regimen best matches those goals?

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Correct answer: B — Start an alpha blocker together with a 5-alpha-reductase inhibitor

The best answer is “Start an alpha blocker together with a 5-alpha-reductase inhibitor”. The alpha blocker provides faster smooth-muscle relaxation, while a 5-alpha-reductase inhibitor is appropriate with demonstrable enlargement and reduces progression over months. Combination therapy aligns with both requested goals. A 5-alpha-reductase inhibitor is appropriate for LUTS with demonstrable prostatic enlargement and may be combined with an alpha blocker when rapid relief and reduced progression risk are both desired.

Reference: American Urological Association Guideline: Benign Prostatic Hyperplasia: https://www.auanet.org/guidelines-and-quality/guidelines/benign-prostatic-hyperplasia-(bph)-guideline