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High-risk non-metastatic hormone-sensitive prostate cancer — MSRA MCQ

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HardProstate CancerHigh-risk non-metastatic hormone-sensitive prostate cancerMSRA

A 66-year-old man has newly diagnosed prostate adenocarcinoma. Multiparametric MRI shows extracapsular extension (cT3a). Biopsy shows Gleason score 4+4=8 (grade group 4) disease and PSA is 24 micrograms/L. CT and bone scan show no nodal or distant metastases. He is ECOG performance status 0, has no significant comorbidity, normal renal and liver function, and no pre-existing peripheral neuropathy. Following MDT discussion, he has chosen radical external beam radiotherapy with long-term androgen-deprivation therapy. Which additional systemic treatment discussion is most appropriate now?

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Correct answer: A — Discuss docetaxel chemotherapy and, if he chooses it, start 6 three-weekly cycles of 75 mg/m² within 12 weeks of starting androgen-deprivation therapy

This patient has newly diagnosed non-metastatic, high-risk prostate cancer: he has cT3a disease and Gleason score 8. He is starting long-term androgen-deprivation therapy (ADT), is fit for chemotherapy and has no important comorbidity. NICE therefore recommends discussing docetaxel, explaining its benefits and harms and making a shared decision. If selected, it should be given as 6 three-weekly cycles of 75 mg/m², started within 12 weeks of ADT initiation. The key distinction is that, in high-risk M0 disease, docetaxel delays clinical progression but has not demonstrated a clear overall-survival benefit. It is consequently a preference-sensitive option rather than mandatory treatment, making B and E incorrect. Abiraterone plus ADT is NICE-recommended for newly diagnosed high-risk hormone-sensitive metastatic prostate cancer, whereas this patient has no metastases, so C is inappropriate. D incorrectly delays a decision that should be made when commencing long-term ADT; docetaxel in this setting is an early treatment option rather than treatment reserved for relapse.

Reference: NICE NG131: Prostate cancer: diagnosis and management, recommendations 1.3.26-1.3.27 (2019; amended 2021) — https://www.nice.org.uk/guidance/ng131/chapter/Recommendations NICE NG131: Rationale and impact, docetaxel chemotherapy (2019; amended 2021) — https://www.nice.org.uk/guidance/ng131/chapter/Rationale-and-impact NICE TA1110: Abiraterone for treating newly diagnosed high-risk hormone-sensitive metastatic prostate cancer, recommendations (19 November 2025) — https://www.nice.org.uk/guidance/ta1110/chapter/1-Recommendations