skip to main content

Localised CPG 3 prostate adenocarcinoma — MSRA MCQ

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

HardProstate CancerLocalised CPG 3 prostate adenocarcinomaMSRA

A 64-year-old man has newly diagnosed prostate adenocarcinoma. Multiparametric MRI shows organ-confined cT2a disease. Targeted biopsy shows Gleason score 3+4=7 (grade group 2) adenocarcinoma, and PSA is 14.2 micrograms/L. Staging shows no nodal or distant metastases. He is fit for radical treatment. Following MDT counselling, he is particularly concerned about urinary and sexual adverse effects and does not wish to have immediate radical prostatectomy or radiotherapy, but is willing to attend regular monitoring and proceed to radical treatment if there is evidence of progression. Which is the most appropriate management strategy?

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

Reveal the answer and explanation

Correct answer: E — Consider active surveillance with protocolled PSA, DRE and MRI monitoring

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

This man has CPG 3 localised prostate cancer: grade group 2 disease together with a PSA of 10–20 micrograms/L and T1–T2 stage. NICE recommends radical prostatectomy or radical radiotherapy for CPG 3 disease. However, active surveillance may be considered for a person with CPG 3 cancer who chooses not to have immediate radical treatment. He is fit for curative treatment, understands the trade-off, accepts close monitoring and would proceed to radical treatment if progression occurs; active surveillance therefore preserves a window for cure. A and C are definitive treatment options, but neither is the best response to his informed preference to defer immediate radical treatment. If he later chose radiotherapy, combination treatment with androgen deprivation would be appropriate for CPG 3 disease. D is not appropriate as sole initial treatment for otherwise localised disease in a man suitable for curative treatment. E is incorrect because watchful waiting has no curative intent and is generally used when radical treatment is unsuitable or unwanted permanently; it is not interchangeable with active surveillance.

Reference: NICE NG131: Prostate cancer: diagnosis and management — Recommendations (Last updated 15 December 2021) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations