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Suspected prostate cancer — MSRA MCQ

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ModerateProstate CancerSuspected prostate cancerMSRA

A 58-year-old man presents to his GP with 4 months of worsening nocturia and urinary hesitancy. He has no dysuria, fever, perineal pain, visible haematuria, urinary retention or bone pain. He has not had a urinary tract infection, catheterisation, ejaculation or vigorous cycling in the preceding 48 hours. Digital rectal examination finds a smoothly enlarged prostate without nodularity or induration. PSA is 3.8 micrograms/L. He is otherwise well, would wish to investigate a possible cancer diagnosis and would be fit for radical treatment if indicated. What is the most appropriate next management step?

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

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Correct answer: D — Make a suspected cancer pathway referral for prostate cancer now

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

This man has possible prostate-cancer symptoms (nocturia and hesitancy) and a PSA above the NICE age-specific threshold for symptomatic people aged 50 to 59 years, which is greater than 3.5 micrograms/L. His PSA is 3.8 micrograms/L. NICE therefore advises considering a suspected cancer pathway referral, taking account of preferences and comorbidity. He is fit for treatment and wishes investigation, so referral should not be delayed. B is initially attractive because transient PSA elevation can occur, but the stem excludes important reversible causes and his result already exceeds the relevant symptomatic referral threshold. C may be appropriate for uncomplicated lower urinary tract symptoms when cancer suspicion is low, but it would defer indicated cancer assessment. D is incorrect because multiparametric MRI is ordinarily the first-line secondary-care investigation after referral for suspected clinically localised prostate cancer, rather than a prerequisite for primary-care referral. E underestimates the cancer risk: a benign-feeling prostate does not override an age-threshold PSA elevation in a symptomatic man.

Reference: Suspected cancer: recognition and referral (NG12) – Recommendations organised by site of cancer (Updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer Prostate cancer: diagnosis and management (NG131) – Assessment and diagnosis (Last updated 15 December 2021; last reviewed August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/recommendations