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Biochemical relapse after radical prostatectomy — MSRA MCQ

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HardPSABiochemical relapse after radical prostatectomyMSRA

A 67-year-old man is followed after radical prostatectomy for pT3a, ISUP Grade Group 3 prostate cancer. His PSA became undetectable after surgery. Using the same assay, PSA values have subsequently risen from 0.12 ng/mL 6 months ago, to 0.22 ng/mL 3 months ago, and 0.40 ng/mL today. He has no bone pain, weight loss, urinary obstruction or neurological symptoms. Staging investigations show no metastases. He is fit for further radical treatment and wishes to pursue treatment with curative intent. What is the most appropriate next management step?

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

Reveal the answer and explanation

Correct answer: A — Refer for radical radiotherapy to the prostatic bed

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

This is biochemical relapse after radical prostatectomy: PSA has risen serially using the same assay, with three measurements over 6 months, and there is no evidence of metastatic disease. He is fit and wants curative-intent management. NICE recommends radical radiotherapy to the prostatic bed for people with biochemical relapse after radical prostatectomy who have no known metastases. A is inappropriate because androgen-deprivation therapy is not routinely indicated for biochemical relapse alone. NICE reserves hormonal therapy for symptomatic local progression, proven metastases, or a PSA doubling time below 3 months. B is incorrect because routine MRI is not recommended before salvage radiotherapy in this setting. C is incorrect because biopsy of the prostatic bed should not be offered after radical prostatectomy. E is tempting because PSA doubling time should be assessed using at least three measurements over at least 6 months; however, this requirement is already met and further delay is not the appropriate next step in a fit man pursuing salvage treatment.

Reference: NICE NG131: Prostate cancer: diagnosis and management — Managing relapse after radical treatment (Last updated 15 December 2021; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng131/chapter/recommendations NICE NG131: Prostate cancer: diagnosis and management — Managing relapse after radical treatment (Last updated 15 December 2021; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng131/chapter/recommendations NICE NG131: Prostate cancer: diagnosis and management — Managing relapse after radical treatment (Last updated 15 December 2021; checked 15 August 2026) — https://www.nice.org.uk/guidance/ng131/chapter/recommendations