Prostate Cancer — SCE Medical Oncology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateUrological CancersProstate CancerSCE Medical Oncology

A 58-year-old man with metastatic castration-resistant prostate cancer on enzalutamide develops new seizures. He has no brain metastases on MRI. What is the most likely drug-related cause?

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

Reveal the answer and explanation

Correct answer: A — Enzalutamide-related seizure (known dose-dependent adverse effect)

Seizures are a recognised adverse effect of enzalutamide (occurring in approximately 0.5-1%), related to its ability to cross the blood-brain barrier and inhibit GABA-A receptors. Enzalutamide is contraindicated in patients with a history of seizures or conditions predisposing to seizures. If seizures occur, enzalutamide must be permanently discontinued. Apalutamide and darolutamide have lower seizure risk. Brain metastases should be excluded but are uncommon in prostate cancer.

Reference: BNF Enzalutamide monograph; NICE TA387; ESMO 2024 Prostate Cancer Guidelines