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Post-radical-treatment follow-up for localised prostate cancer — MSRA MCQ

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ModerateProstate CancerPost-radical-treatment follow-up for localised prostate cancerMSRA

A 67-year-old man attends his GP 4 weeks after robot-assisted radical prostatectomy for localised prostate adenocarcinoma. He is recovering well, has no bone pain or urinary symptoms, and has not received adjuvant treatment. The urology discharge plan requests PSA surveillance in primary care. He asks whether a PSA test and digital rectal examination (DRE) should be arranged today. Which follow-up plan is most appropriate?

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Correct answer: D — Measure PSA no earlier than 6 weeks, repeat it at least every 6 months for 2 years, without routine DRE while PSA is at baseline

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

The first post-radical-treatment PSA should be checked no earlier than 6 weeks after treatment; at 4 weeks, testing is premature. NICE advises PSA measurement at least every 6 months for the first 2 years and at least annually thereafter. In a person with localised prostate cancer who is not on active surveillance, routine DRE is not recommended while the PSA remains at baseline levels. A is wrong because both the timing of PSA testing and routine DRE are inappropriate. B correctly limits DRE to a potentially indicated context, but still tests PSA too early. C has the correct initial PSA timing and 6-monthly interval, but routine DRE adds no value when PSA remains at baseline. E delays the initial PSA beyond the recommended earliest assessment and uses annual testing too soon after radical treatment. This question distinguishes surveillance after curative treatment from active-surveillance protocols, in which DRE and MRI can have defined roles.

Reference: NICE NG131: Prostate cancer: diagnosis and management, recommendations 1.3.47-1.3.48 (Published 2019; last updated 15 December 2021; last reviewed 13 August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations