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EAU, Chapter 4 MCQs
EAU · MBBS / Medicine · 21 practice questions
- Risk-stratified radiotherapy dose and ADT combinations
- Active surveillance in intermediate-risk prostate cancer
- High-risk localised disease - lymph node management
- Supportive care and monitoring in castration-resistant disease
- Castration-resistant PCa diagnosis - testosterone criteria
- Metastatic hormone-sensitive prostate cancer management
- Intermediate-risk PCa radiotherapy with ADT
- Persistent PSA after radical prostatectomy
1. A man with metastatic castration-resistant prostate cancer was treated with docetaxel followed by abiraterone. His disease progresses 8 months after starting abiraterone. Which agent is most appropriate to offer next?
- ACabazitaxel
- BRepeat docetaxel at standard dose
- CContinue abiraterone at higher dose
- DSipuleucel-T as monotherapy
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A. Cabazitaxel Cabazitaxel is specifically recommended for patients previously treated with docetaxel who progress within 12 months of treatment with abiraterone or enzalutamide, matching this scenario's 8-month progression. Repeating docetaxel is not the recommended next step after this progression pattern. Continuing or escalating abiraterone despite progression is not supported by the guidance. Sipuleucel-T is listed as a life-prolonging option in hormone-sensitive PCa treatment history considerations but not specifically indicated here as the described next step after abiraterone failure within 12 months post-docetaxel.
2. A patient on long-term LHRH agonist therapy for metastatic prostate cancer develops rising PSA and new bone pain. Before labelling him as having castration-resistant disease, which additional test result must be confirmed?
- ATestosterone level < 50 ng/dL
- BAlkaline phosphatase within normal range
- CTestosterone level < 100 ng/dL
- DPSA-DT < 12 months
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A. Testosterone level < 50 ng/dL Castration-resistant PCa can only be diagnosed after confirming testosterone levels are below 50 ng/dL; using a threshold of 100 ng/dL is incorrect and not the specified cutoff. PSA-DT <12 months relates to ADT monotherapy or systemic salvage treatment criteria, not to the definition of castration resistance. Alkaline phosphatase is monitored during follow-up but is not the defining criterion for castration resistance.
3. A 63-year-old man is diagnosed with intermediate-risk prostate cancer. Biopsy shows a small volume of Gleason pattern 4 disease, and after detailed counselling he wishes to avoid immediate treatment. According to guidance, which statement best reflects the appropriate use of active surveillance in this scenario?
- AActive surveillance should never be offered to intermediate-risk patients regardless of the amount of Gleason pattern 4 present
- BActive surveillance should be combined with adjuvant androgen deprivation therapy to offset the risk of Gleason pattern 4 disease
- CActive surveillance can be offered only if less than 10% of the biopsy cores show Gleason pattern 4, with the patient accepting a potentially increased risk of further metastases
- DActive surveillance is appropriate only if the patient has a life expectancy less than 10 years
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C. Active surveillance can be offered only if less than 10% of the biopsy cores show Gleason pattern 4, with the patient accepting a potentially increased risk of further metastases The text states active surveillance may be offered to 'highly selected patients (< 10% Gleason pattern 4) accepting the potential increased risk of further metastases' — a weak recommendation specific to a threshold of Gleason 4 involvement. Never offering it contradicts the text; life expectancy <10 years is not the stated criterion (that criterion relates to RP candidacy); combining with ADT is not part of the active surveillance recommendation.
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