Prostate Active Surveillance — SCE Medical Oncology MCQ

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EasyUrological CancersProstate Active SurveillanceSCE Medical Oncology

A 55-year-old man is diagnosed with localised prostate cancer (Gleason 3+3=6, PSA 5.2 ng/mL, T1c, 2/12 cores positive with maximum 10% core involvement). According to NICE guidelines, what is the preferred initial management?

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Correct answer: A — Active surveillance

For low-risk localised prostate cancer (Gleason ≤6, PSA <10, ≤T2a), active surveillance is the preferred management strategy per NICE NG131. The ProtecT trial showed equivalent 15-year prostate cancer mortality (~3%) for active surveillance vs radical prostatectomy vs radiotherapy in mainly low-risk disease. Active surveillance avoids treatment-related morbidity (erectile dysfunction, incontinence) while monitoring for reclassification requiring intervention.

Reference: NICE NG131 Prostate cancer; ProtecT Hamdy et al NEJM 2023; ESMO 2024 Prostate Cancer Guidelines