104

Evaluation and Nonsurgical

Management of Benign Prostatic

Hyperplasia

Thomas Anthony McNicholas; Mark J. Speakman; Roger S. Kirby

Questions

1.Where does benign prostatic hyperplasia (BPH) originate? In the:

a.transition zone.

b.peripheral zone.

c.periurethral glands.

d.transition zone and periurethral zone.

e.peripheral and periurethral zones.

2.A strong correlation exists between prostate volume and:

a.serum prostate-specific antigen (PSA).

b.American Urological Association (AUA) symptom score.

c.peak urinary flow rate.

d.postvoid residual.

e.all of the above

3.Medications that may exacerbate lower urinary tract symptoms (LUTS) include:

a.α-adrenergic antagonists.

b.α-adrenergic agonists.

c.β-adrenergic agonists.

d.muscarinic agonists.

e.phytotherapy.

4.What is the primary objective of the digital rectal examination (DRE) in evaluation of men with LUTS? To:

a.estimate prostate volume.

b.obtain prostatic secretions.

c.identify prostate nodules.

d.determine rectal tone.

e.assess for prostatic tenderness.

5.In older men with LUTS, which test should be routinely performed to obtain the differential diagnosis?

a.Urinalysis

b.Peak flow rate

c.Serum creatinine assay

d.Renal ultrasonography

e.Flexible cystoscopy

6.It is advisable in a man with LUTS/BPH and a slightly elevated creatinine level to perform:

a.transurethral resection of the prostate (TURP).

b.intravenous pyelogram.

c.renal ultrasound.

d.urodynamic study.

e.flexible cystoscopy.

7.What percentage of men have histologically proven BPH with a serum PSA value of 4.0 ng/mL or greater?

a.5%

b.15%

c.30%

d.50%

e.80%

8.An AUA symptom score of 20 indicates severe:

a.LUTS.

b.BPH.

c.bladder outlet obstruction.

d.bladder dysfunction.

e.overactive bladder (OAB).

9.An absolute indication for surgery (TURP or open prostatectomy) is:

a.severe symptoms.

b.postvoid residual (PVR) urine of 300 mL or more.

c.single episodes of acute urinary retention.

d.refractory gross hematuria secondary to BPH.

e.Lack of response to an alpha blocker.

.A low peak flow rate suggests:

a.severe symptoms.

b.bladder outlet obstruction.

c.impaired detrusor contractility.

d.b or c.

e.detrusor overactivity.

.What is the next step for a man with a PVR of 300 mL?

a.Repeat the PVR assay

b.Upper urinary tract imaging

c.Urodynamic testing

d.Cystoscopy

e.TURP

.The probability that a urodynamic study helps to decrease the failure rate of TURP in men with a peak flow rate of 15 mL/sec is approximately:

a.10%.

b.25%.

c.50%.

d.75%.

e.95%.

.What is the percentage of men with LUTS who have uninhibited contraction?

a.10%

b.30%

c.60%

d.80%

e.95%

.What is the likelihood that uninhibited detrusor contractions (UDCs) in men with BPH will resolve after TURP?

a.Never

b.Unlikely

c.Likely

d.Always

.The finding of bladder trabeculation suggests:

a.high-grade obstruction.

b.high successful rate after TURP.

c.high PVR.

d.chronic inflammation.

e.none of the above.

a.Severe

b.Moderate

c.Minimal

d.Bothersome

.Smooth muscle accounts for what percentage of the area density of the prostate?

a.5%

b.10%

c.20%

d.40%

e.60%

.The tension of prostate smooth muscle is mediated by the:

a.α1 receptor.

b.α2 receptor.

c.β1 receptor.

d.β2 receptor.

e.muscarinic cholinergic receptor.

.What is the advantage of terazosin versus prazosin?

a.Its longer half-life

b.Its better absorption

c.Its greater α1-receptor selectivity

d.None of the above.

.Which α1 receptor subtype mediates prostate smooth muscle tension?

a.α1a

b.α1b

c.α1c

d.α1d

e.None of the above

.The improvement in AUA symptom score after terazosin administration depends on baseline:

a.age.

b.prostate size.

c.PVR.

d.None of the above.

.The mean treatment-related improvement in response to terazosin in AUA symptom score units is approximately:

a.2.

b.4.

c.6.

d.8.

.The durability of the improvement in symptom scores and peak flow rates for α1-adrenergic blockers has been reported to be up to how many months?

a.12

b.42

c.60

d.92

.Which of the following α-adrenergic blockers does not lower blood pressure in men with uncontrolled hypertension?

a.Terazosin

b.Doxazosin

c.Tamsulosin

d.Prazosin

.Retrograde ejaculation is most commonly seen with:

a.terazosin.

b.silodosin.

c.finasteride.

d.tamsulosin.

e.alfuzosin.

.Approximately what percentage of men have both BPH and hypertension?

a.5%

b.15%

c.30%

d.50%

e.70%

.What is the likely mechanism for dizziness after α1-adrenergic blocker therapy?

a.Vascular

b.Central nervous system

c.Carotid baroreceptor

d.None of the above

.The major advantage of tamsulosin 0.4 mg versus terazosin 10 mg is:

a.greater efficiency.

b.less retrograde ejaculation.

c.no dose titration.

d.greater lowering of blood pressure.

.The embryologic development of the prostate is mediated primarily by:

a.testosterone.

b.dihydrotestosterone.

c.androstenedione.

d.estradiol.

.Finasteride significantly decreases the long-term risk of:

a.acute urinary retention.

b.surgical intervention.

c.symptom progression.

d.all of the above.

e.none of the above.

.Finasteride is most effective at relieving hematuria in men with:

a.prostatitis.

b.enlarged prostate.

c.transurethral prostatectomy.

d.obstructing prostate.

e.small prostates

.Dutasteride:

a.is a dual inhibitor of type 1 and type 2 5α-reductase.

b.is more effective than finasteride.

c.results in a 95% reduction in PSA after 6 months of therapy.

d.is less likely than finasteride to result in loss of libido.

e.is cheaper than finasteride.

.The adverse event that limits the use of flutamide as a primary treatment of BPH is:

a.breast tenderness.

b.diarrhea.

c.erectile dysfunction.

d.loss of libido.

.A potential advantage of cetrorelix, a gonadotropin-releasing hormone antagonist, for the treatment of BPH is:

a.lower cost.

b.ability to titrate the level of androgen suppression.

c.ease of administration.

d.rapid response.

.A Veterans Affairs study demonstrated that terazosin is more effective than finasteride at rapidly relieving symptoms in men with:

a.small prostates.

b.intermediate-size prostates.

c.large prostates.

d.all of the above.

.The Medical Therapy of Prostatic Symptoms (MTOPS) study confirmed that:

a.α-adrenergic blockers and 5α-reductase inhibitors are equivalent in relieving symptoms.

b.α-adrenergic blockers reduce the risk of acute urinary retention during 7 years of treatment.

c.finasteride reduces the risk of adenocarcinoma of the prostate.

d.a combination of an α-adrenergic blocker and a 5α-reductase inhibitor is the most effective way of preventing BPH progression.

e.combination therapy was more effective than monotherapy after 6 months’ treatment.

.The Combination of Avodart and Tamsulosin (CombAT) Study showed that in men with larger prostates:

a.the combination of dutasteride and tamsulosin was more effective than either agent alone.

b.with time, the symptomatic response to dutasteride exceeded that to tamsulosin.

c.both of the above.

d.none of the above.

e.tamsulosin did not affect ejaculation.

.Combination therapy in LUTS/BPH using dutasteride and tamsulosin:

a.should be continued long-term in all patients who respond.

b.may be reduced to dutasteride alone after 6 months in all patients.

c.may be reduced to dutasteride alone in 80% of patients with a baseline IPSS less than 20, after 6 months’ treatment.

d.may be reduced to dutasteride alone in all patients with a baseline IPSS less than 20, after 6 months’ treatment.

e.may be reduced to tamsulosin alone in in 80% of patients with a baseline IPSS less than 20, after 6 months’ treatment.

.The CombAT study showed that in men with a pretreatment PSA between 1.5 and 10 ng/mL:

a. the combination of dutasteride and tamsulosin was more effective than