skip to main content

Benign prostatic hyperplasia — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardWomen's/Men's HealthBenign prostatic hyperplasiaABIM Board

A 68-year-old man has persistent moderate lower urinary tract symptoms after three months of tamsulosin. Prostate volume is 58 mL, PSA is stable at 2.7 ng/mL, urinalysis is normal and postvoid residual is 70 mL. He prioritizes reducing future urinary-retention and surgery risk. Which addition is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Add finasteride and counsel that maximal symptom benefit takes months

The best answer is “Add finasteride and counsel that maximal symptom benefit takes months”. A prostate larger than approximately 30 to 40 mL predicts benefit from a 5-alpha-reductase inhibitor. Finasteride gradually reduces gland size and lowers progression, urinary-retention and surgery risk, while the alpha blocker provides faster symptom relief. The alternatives may address selected symptoms but do not provide the same prostate-volume and progression benefit.

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