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PI-RADS 5 — SCE Medical Oncology MCQ

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HardUrological CancersPI-RADS 5SCE Medical Oncology

A 67-year-old man with Cambridge Prognostic Group 1 prostate cancer is on active surveillance. At month 20 his PSA trajectory becomes concerning, although digital rectal examination is unchanged and he is asymptomatic. What is the NICE-aligned next step?

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Correct answer: B — Arrange multiparametric MRI now and decide on targeted or systematic re-biopsy

Option B is correct: a concerning PSA trajectory triggers multiparametric MRI and consideration of re-biopsy. Option E delays a triggered reassessment. Option C treats biochemical concern as proven progression. Option A increases PSA frequency but still delays imaging, and option D substitutes PSMA PET-CT for the recommended local reassessment pathway.

Reference: NICE NG131: prostate cancer diagnosis and management. https://www.nice.org.uk/guidance/ng131/chapter/Recommendations