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Male lower urinary tract symptoms following treated urinary tract infection — MSRA MCQ

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ModerateLUTSMale lower urinary tract symptoms following treated urinary tract infectionMSRA

A 66-year-old man presents with an 8-month history of bothersome hesitancy, weak urinary stream and nocturia. His symptoms are now back to their usual baseline following a culture-confirmed Escherichia coli lower urinary tract infection treated successfully with nitrofurantoin. His dysuria and frequency resolved 2 weeks ago, and a repeat urine dipstick is negative for leucocytes, nitrites and blood. He has no visible haematuria, bone pain, weight loss or urinary retention. Digital rectal examination shows a smooth, symmetrically enlarged prostate. After discussion of the potential benefits and limitations of testing, he wishes to have a PSA test. He has not ejaculated or undertaken vigorous cycling in the previous 48 hours. What is the most appropriate next step regarding PSA testing?

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

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Correct answer: A — Arrange a PSA test after a further 2 weeks

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

PSA testing should be deferred following a urinary tract infection because infection can transiently raise the PSA concentration and create an uninterpretable result. The NHS advises waiting 4–6 weeks after the infection has cleared before testing. This man’s infection resolved 2 weeks ago, so the appropriate plan is to arrange PSA testing in a further 2 weeks, reaching the earliest recommended 4-week interval. A is inappropriate because testing now is too soon after a proven UTI and could lead to an avoidable false-positive result, anxiety and unnecessary referral. B and C remain within the first 4 weeks after resolution. D would produce an interpretable result but unnecessarily delays assessment in a man with persistent obstructive LUTS who has made an informed choice to undergo PSA testing. Avoiding ejaculation and vigorous exercise for 48 hours is appropriate preparation, but it does not remove the need to defer testing after infection. NICE recommends discussing PSA testing with men whose LUTS suggest bladder outlet obstruction secondary to benign prostatic enlargement, after allowing time for informed decision-making.

Reference: PSA test (Last reviewed 2 September 2024) — https://www.nhs.uk/tests-and-treatments/psa-test/ Lower urinary tract symptoms in men: management — recommendation 1.1.5 (2010; current NICE guidance page checked August 2026) — https://www.nice.org.uk/guidance/cg97/chapter/recommendations