skip to main content

Biochemical relapse after radical radiotherapy for prostate cancer — MSRA MCQ

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

HardPSABiochemical relapse after radical radiotherapy for prostate cancerMSRA

A 70-year-old man is followed by oncology after radical external-beam radiotherapy for localised prostate cancer 5 years ago. His post-treatment PSA nadir was 0.3 ng/mL. Biochemical relapse has been confirmed by the specialist team. Using the same assay, his PSA has risen from 1.2 ng/mL 6 months ago, to 1.7 ng/mL 3 months ago, and to 2.4 ng/mL today. He is well, with no bone pain, weight loss, neurological symptoms or troublesome urinary symptoms. Recent staging has shown no metastases. He is not pursuing local salvage treatment or a clinical trial. What is the most appropriate management of androgen-deprivation therapy at this stage?

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

Reveal the answer and explanation

Correct answer: A — Do not commence androgen-deprivation therapy; calculate PSA doubling time from the serial results and continue specialist surveillance

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

This man has biochemical relapse after radical radiotherapy, but a rising PSA alone does not justify immediate androgen-deprivation therapy (ADT). The serial values permit estimation of PSA doubling time because there are 3 measurements spanning 6 months. His PSA has doubled over approximately 6 months, which is not the high-risk threshold of a PSA doubling time below 3 months. He also has neither symptomatic local progression nor proven metastatic disease. NICE advises against routinely offering hormonal therapy for biochemical relapse unless there is symptomatic local progression, proven metastases, or a PSA doubling time of less than 3 months. Therefore, the appropriate next step is to calculate and document PSA doubling time and continue specialist surveillance. A and C incorrectly treat biochemical relapse or an absolute PSA rise as sufficient indications for ADT. B is attractive because intermittent ADT can be used in some long-term settings, but it does not remove the requirement for an indication to start hormonal treatment. D similarly exposes him to treatment adverse effects without a NICE indication. Biopsy and routine prostate MRI are not required for this systemic-treatment decision, particularly as he is not considering local salvage therapy.

Reference: NICE NG131: Prostate cancer: diagnosis and management — Managing relapse after radical treatment (Last updated December 2021; last reviewed August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations NICE NG131: Prostate cancer: diagnosis and management — Recommendation 1.3.59 (Last updated December 2021; last reviewed August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations