skip to main content

Enzalutamide PRCA — SCE Medical Oncology MCQ

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

HardUrological CancersEnzalutamide PRCASCE Medical Oncology

A 72-year-old man with metastatic prostate cancer develops symptomatic anaemia (Hb 78 g/L) while on enzalutamide. His reticulocyte count is low, LDH normal, haptoglobin normal. Bone marrow biopsy shows normal cellularity with no infiltration. B12 and folate are normal. Iron studies are normal. What is the most likely cause?

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

Reveal the answer and explanation

Correct answer: B — Enzalutamide-induced pure red cell aplasia

Pure red cell aplasia (PRCA) is a rare but recognised adverse effect of androgen receptor pathway inhibitors, particularly enzalutamide. It presents with isolated severe anaemia with absent/very low reticulocytes, normal WBC/platelets, and normal bone marrow cellularity except for erythroid hypoplasia. Management includes enzalutamide discontinuation and corticosteroid trial. Anti-erythropoietin antibody testing may be helpful. The mechanism is likely immune-mediated. Recovery occurs in most cases after drug withdrawal.

Reference: BNF Enzalutamide monograph; Case reports in Annals of Oncology and Blood; ESMO Prostate Cancer Guidelines