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Metastatic hormone-sensitive prostate cancer with spinal metastases — MSRA MCQ

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HardProstate CancerMetastatic hormone-sensitive prostate cancer with spinal metastasesMSRA

A 72-year-old man has newly diagnosed, biopsy-confirmed metastatic hormone-sensitive prostate adenocarcinoma. CT staging demonstrates multiple sclerotic vertebral metastases, including at T7 and L3. He has no back pain, radicular pain, limb weakness, sensory loss, gait disturbance, or bladder or bowel dysfunction. The MDT recommends immediate long-term androgen-deprivation therapy; degarelix is locally commissioned for its NICE-approved indication. Which is the most appropriate initial hormonal treatment regimen?

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

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Correct answer: E — Administer degarelix 240 mg subcutaneously, followed by 80 mg subcutaneously monthly

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

Degarelix is the best initial regimen. This man has advanced hormone-sensitive prostate cancer with spinal metastases, a subgroup for whom NICE recommends degarelix where locally commissioned. As a GnRH antagonist, degarelix rapidly suppresses testosterone and does not produce the initial testosterone surge that can occur with GnRH agonists. This avoids potential tumour flare in a patient with vertebral metastatic disease. A GnRH agonist alone (A) risks flare-related worsening of metastatic symptoms, including neurological compromise or urinary obstruction. Bicalutamide can be used as flare protection with a GnRH agonist, but it should be started before the agonist; starting both on the same day does not provide the intended pre-treatment protection. Bicalutamide monotherapy (D) is not the preferred approach for metastatic hormone-sensitive disease when effective castration-based therapy is indicated. He has no symptoms or signs of metastatic spinal cord compression, so urgent MRI and dexamethasone are not indicated solely because vertebral metastases are present; therefore E is incorrect. New neurological symptoms would instead require immediate MSCC-pathway assessment.

Reference: Degarelix for treating advanced hormone-dependent prostate cancer: Recommendations (2016; reviewed October 2020) — https://www.nice.org.uk/guidance/ta404/chapter/1-recommendations Degarelix Ferring 80 mg: Summary of Product Characteristics (2025) — https://www.medicines.org.uk/emc/product/100905/smpc Decapeptyl SR 11.25 mg: Summary of Product Characteristics (2026) — https://www.medicines.org.uk/emc/product/780/smpc