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Urology: Prostate ADT duration with radical RT

Free question published 01 August 2026

UrologyProstate ADT duration with radical RT

A 68-year-old man has locally advanced prostate cancer (cT3b N0 M0, Gleason 4+5=9, PSA 28 ng/mL), corresponding to a high Cambridge Prognostic Group. He is fit and proceeds to radical external beam radiotherapy with androgen deprivation therapy. What duration of androgen deprivation therapy should be discussed alongside his radiotherapy?

  1. ANo androgen deprivation therapy; radiotherapy alone
  2. B3 months of neoadjuvant androgen deprivation therapy only
  3. CLifelong continuous androgen deprivation therapy
  4. D6 weeks of androgen deprivation therapy during radiotherapy only
  5. E6 months of androgen deprivation therapy, with consideration of continuing for up to 3 years

Why E is correct

NICE NG131 recommends 6 months of androgen deprivation therapy for CPG 2 to 5 disease receiving radical external beam radiotherapy (1.3.22), and consideration of continuing for up to 3 years in CPG 4 and 5 disease (1.3.23). The long-course benefit is supported by EORTC 22863, in which 3 years of androgen suppression improved overall survival in locally advanced prostate cancer.

And why the others are not

  • AIncorrect: high-risk locally advanced disease benefits from combined androgen deprivation therapy; radiotherapy alone is inferior per EORTC 22863.
  • BIncorrect: a short 3-month neoadjuvant-only course is insufficient for high-risk locally advanced disease under NICE NG131.
  • CIncorrect: lifelong androgen deprivation therapy is not indicated for non-metastatic disease treated with curative radiotherapy.
  • DIncorrect: a 6-week course is far shorter than the evidence-based 6-month to 3-year durations.

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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