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Urology: Low-risk prostate active surveillance

Free question published 12 August 2026

UrologyLow-risk prostate active surveillance

A 62-year-old man is found to have prostate cancer on biopsy: cT1c, Gleason 3+3=6 (Grade Group 1), PSA 6.2 ng/mL, with cancer in 2 of 12 cores. He has no urinary symptoms and a normal performance status. What is the most appropriate management?

  1. AActive surveillance
  2. BRadical prostatectomy
  3. CRadical radiotherapy with 6 months of androgen deprivation therapy
  4. DLow-dose-rate brachytherapy monotherapy
  5. EImmediate androgen deprivation therapy

Why A is correct

This is Cambridge Prognostic Group 1 (low-risk) localised disease. NICE NG131 (1.3.8) recommends offering active surveillance, considering radical prostatectomy or radical radiotherapy only if active surveillance is unsuitable or unacceptable.

And why the others are not

  • BIncorrect: radical prostatectomy is only considered if active surveillance is not suitable or acceptable.
  • CIncorrect: radical radiotherapy with androgen deprivation is reserved for higher-risk disease or when surveillance is declined, and ADT is not indicated in CPG 1.
  • DIncorrect: brachytherapy is a radical option, not the first-line recommendation over surveillance for CPG 1 disease.
  • EIncorrect: androgen deprivation therapy is not appropriate as primary treatment for low-risk localised disease.

Source NICE NG131 — Prostate cancer: diagnosis and management — National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE guideline NG131. Published 09/05/2019, updated 15/12/2021.

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