Nocturia and Prostatic Enlargement

🗒️ Question

A 70 year old man presents to his GP with difficulty urinating, including weak stream and a feeling of incomplete bladder emptying. He reports waking several times at night to urinate and occasional discomfort in the perineal area. He denies any haematuria or weight loss. His past medical history includes hypertension, for which he takes amlodipine.

On examination, his abdomen is soft and digital rectal examination reveals an enlarged, irregular prostate.

Investigations

• Prostate-specific antigen (PSA): 12 µg/L (<4)

• Creatinine: 90 µmol/L (62–106)

• Urinalysis: No abnormalities detected

Which is the most appropriate next investigation?

(A) Abdominal ultrasound

(B) Multiparametric MRI of the prostate

(C) Pelvic CT scan

(D) Transrectal ultrasound-guided biopsy

(E) Bone scan