A 60-Year-Old Man with a Past Medical History of Hypertension

question 900

Multiple Choice

A 60-year-old man with a past medical history of hypertension comes to the physician complaining of urinary symptoms.  Over the last 6 months, he has had a decreased urinary stream and an occasional uncomfortable sensation while urinating.  He awakens once a night to urinate but sometimes feels that he needs to go again.  The symptoms do not bother him much at this point, but he is afraid that they may worsen.  He has no family history of prostate problems.  He has no fever, malaise, back pain, cloudy urine, or blood in the urine.
Digital rectal examination shows a moderately enlarged and rubbery prostate.  The remainder of the physical examination is unremarkable.
Laboratory results are as follows:

Which of the following is the best next step in managing this patient?

• A)5-alpha-reductase inhibitor
• B)Alpha-1-adrenergic antagonist
• C)Re-evaluation in 3-6 months
• D)Referral to urologist
• E)Renal ultrasound

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