skip to main content

Metastatic hormone-sensitive prostate cancer receiving long-term androgen-deprivation therapy — MSRA MCQ

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

HardProstate CancerMetastatic hormone-sensitive prostate cancer receiving long-term androgen-deprivation therapyMSRA

A 72-year-old man with metastatic hormone-sensitive prostate adenocarcinoma has received continuous leuprorelin for 4 years. At diagnosis he had pelvic nodal and vertebral metastases. He has had no skeletal events, his PSA has remained below 0.1 micrograms/L for 18 months, and recent CT shows stable disease. He has no bone pain, neurological symptoms, urinary obstruction or other evidence of progression. He reports troublesome hot flushes, fatigue and loss of libido despite supportive measures, and asks whether treatment can be paused. He did not receive androgen-deprivation therapy as adjuvant treatment to radical therapy. Which is the most appropriate management plan?

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

Reveal the answer and explanation

Correct answer: E — Consider intermittent androgen-deprivation therapy, with PSA measurement every 3 months and restarting treatment if PSA reaches 10 nanograms/mL or symptomatic progression occurs.

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

This man is receiving long-term androgen-deprivation therapy (ADT) for metastatic disease rather than as adjuvant treatment after radical therapy. NICE advises that intermittent ADT can be considered in this setting, with discussion of its rationale, uncertain side-effect benefit and possible effects on progression. If intermittent ADT is used, PSA should be measured every 3 months and ADT restarted at PSA 10 nanograms/mL or if symptomatic progression occurs. A is plausible because continuous ADT remains standard and his disease is controlled, but it ignores the guideline-supported option of intermittent treatment for troublesome adverse effects. C uses an incorrect monitoring interval and restart threshold. D is initially attractive because bicalutamide monotherapy may better preserve sexual function, but it is a first-line option for selected people willing to accept reduced overall survival and gynaecomastia; it is not the recommended substitution for a patient responding to established ADT. E risks allowing clinically important progression because treatment should not wait for radiological progression alone.

Reference: NICE guideline NG131: Prostate cancer: diagnosis and management, recommendations 1.4.1–1.4.2 (Last updated 15 December 2021; guideline surveillance reviewed August 2025) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations May 2025 and August 2025 exceptional surveillance of prostate cancer: diagnosis and management (NICE guideline NG131) (13 August 2025) — https://www.nice.org.uk/guidance/ng131/evidence/may-2025-exceptional-surveillance-of-prostate-cancer-diagnosis-and-management-nice-guideline-ng131-15368818141