skip to main content

Possible prostate cancer — MSRA MCQ

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

ModerateProstate CancerPossible prostate cancerMSRA

A 59-year-old man presents with 5 months of nocturia, urinary hesitancy and reduced urinary stream. He has no dysuria, fever, visible haematuria, perineal pain, bone pain or weight loss. Urine dipstick is negative for blood, leucocytes and nitrites. Digital rectal examination shows a smoothly enlarged prostate with no nodularity or induration. His PSA, measured before DRE, is 4.1 micrograms/L. He has had no urinary tract infection, urinary retention, catheterisation, ejaculation or vigorous cycling in the preceding 48 hours. He is fit for radical treatment if clinically significant cancer is found and wishes to pursue investigation. 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: B — Make a suspected cancer pathway referral for prostate cancer

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

This man should be referred on a suspected cancer pathway. NICE advises considering this referral for people with lower urinary tract symptoms, erectile dysfunction or visible haematuria when PSA exceeds the age-specific threshold. For men aged 50–59 years, the threshold is more than 3.5 micrograms/L; his PSA of 4.1 micrograms/L is therefore above threshold. A benign-feeling prostate does not override an elevated PSA-based referral indication. The absence of recognised short-term causes of PSA elevation and his willingness and fitness for potentially radical treatment further support proceeding directly to referral. A is inappropriate because empirical treatment for likely benign prostatic enlargement must not defer appropriate cancer assessment. B would be reasonable if there were a plausible transient PSA elevation, such as recent urinary infection or instrumentation, but none is present. D under-triages a patient meeting criteria for a suspected cancer pathway referral. E applies the wrong interpretation of the age-specific threshold; he remains in the 50–59-year age band at the time of testing.

Reference: NICE NG12: Suspected cancer: recognition and referral — recommendations organised by site of cancer (Updated 15 April 2026) — https://www.nice.org.uk/guidance/ng12/chapter/recommendations-organised-by-site-of-cancer