skip to main content

Localised CPG2 prostate adenocarcinoma — MSRA MCQ

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

ModerateProstate CancerLocalised CPG2 prostate adenocarcinomaMSRA

A 66-year-old man has newly diagnosed prostate adenocarcinoma. Multiparametric MRI shows organ-confined disease (cT2b), and targeted biopsy shows Gleason score 3+4=7 (grade group 2) adenocarcinoma. PSA is 8.7 micrograms/L. Staging shows no nodal or distant metastases. He is fit for curative treatment and, following MDT discussion, chooses radical external beam radiotherapy. Which androgen-deprivation treatment duration is most appropriate to use with his radiotherapy?

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

Reveal the answer and explanation

Correct answer: B — Androgen-deprivation therapy for a total of 6 months

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

This man has CPG2 localised prostate cancer: grade group 2 disease, PSA below 10 micrograms/L and organ-confined staging. For people with CPG2 localised prostate cancer receiving radical external beam radiotherapy, NICE recommends combining radiotherapy with androgen-deprivation therapy (ADT), rather than using either treatment alone. NICE specifies 6 months of ADT, which may be given before, during or after radiotherapy. A is inappropriate because radiotherapy alone omits the recommended treatment intensification for CPG2 disease. C, D and E use longer ADT durations. Prolonged ADT for up to 3 years may be considered for CPG4 or CPG5 localised or locally advanced disease, balancing benefit against adverse effects such as hot flushes, sexual dysfunction, metabolic effects and bone loss. His CPG2 disease does not justify extending ADT beyond the standard 6-month course. The decisive distinction is therefore risk group, rather than the fact that radiotherapy is being used.

Reference: NICE NG131: Prostate cancer: diagnosis and management — recommendations 1.3.21 to 1.3.23 (Updated December 2021; last reviewed August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations