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Prostate Cancer — SCE Medical Oncology MCQ

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HardUrological CancersProstate CancerSCE Medical Oncology

A man with hormone-relapsed metastatic prostate cancer progresses after abiraterone. Tumour sequencing shows a pathogenic biallelic BRCA2 alteration and MSI-high status. He has not received a PARP inhibitor. Which biomarker-directed NHS treatment is supported by NICE?

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Correct answer: A — Olaparib monotherapy under the BRCA1/2-mutated prostate-cancer recommendation

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

C is correct. NICE TA887 recommends olaparib monotherapy for BRCA1- or BRCA2-mutated hormone-relapsed metastatic prostate cancer after progression on a newer hormonal treatment such as abiraterone. MSI-high status is biologically relevant but does not create a NICE prostate indication for pembrolizumab or establish an olaparib-pembrolizumab combination as standard NHS therapy. A therefore assumes a commissioning route that is not present. B is experimental rather than an approved dual-biomarker standard. D is selected by symptomatic bone-predominant disease and other eligibility factors, not MSI. E is a second androgen-receptor-pathway drug with expected cross-resistance and does not exploit BRCA2 loss.

Reference: NICE TA887 olaparib recommendations: https://www.nice.org.uk/guidance/ta887/chapter/1-Recommendations