skip to main content

Benign prostatic hyperplasia with new visible haematuria — MSRA MCQ

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

HardBPHBenign prostatic hyperplasia with new visible haematuriaMSRA

A 71-year-old man with known benign prostatic hyperplasia has taken tamsulosin MR 400 micrograms daily for 18 months, with good improvement in hesitancy and weak stream. He reports two episodes of painless visible haematuria over the past 5 days. He has no dysuria, fever, loin pain, recent instrumentation or trauma. Urine dipstick is positive for blood but negative for leucocytes and nitrites; a midstream urine culture shows no growth. His eGFR is unchanged from baseline. Digital rectal examination shows a smooth enlarged prostate, and PSA measured 4 months ago was 2.1 micrograms/L. What is the most appropriate next management step?

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

Reveal the answer and explanation

Correct answer: E — Make a suspected cancer pathway referral for haematuria assessment

Explanation lettering: C = shown as A · A = shown as B · D = shown as C · E = shown as D · B = shown as E

This man requires a suspected cancer pathway referral. He is over 45 years old and has unexplained visible haematuria: there is no clinical or microbiological evidence of urinary infection, and no alternative transient cause is identified. Established BPH, a benign digital rectal examination and a recent non-elevated PSA do not adequately explain or exclude important urothelial or renal tract pathology. NICE recommends suspected cancer pathway referral for visible haematuria in people aged 45 years or over when it occurs without UTI, or persists or recurs after successful treatment of UTI. A is inappropriate because primary-care imaging should not be used to gatekeep referral; a normal ultrasound would not exclude important lower tract pathology. C delays urgent assessment and repeats tests that do not alter the referral criterion. D wrongly attributes new visible haematuria to known BPH; symptom control does not replace investigation for malignancy. E would be appropriate if there were a clinically suspected or culture-supported UTI, but neither is present.

Reference: NICE NG12: Suspected cancer: recognition and referral — Recommended actions organised by symptom and findings of primary care investigations (Updated April 2026) — https://www.nice.org.uk/guidance/NG12/chapter/recommended-actions-organised-by-symptom-and-findings-of-primary-care-investigations NICE CG97: Lower urinary tract symptoms in men: management — Initial assessment (2010; surveillance current) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations