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General Surgery · Urology: prostate cancer diagnosis
Sample itemA 66-year-old has a PSA of 14 ng/mL. What is the best next step to diagnose prostate cancer?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Multiparametric MRI followed by targeted biopsy
MRI before biopsy identifies clinically significant lesions and allows targeted sampling in addition to systematic cores, and the Gleason or ISUP grade then guides treatment. Treatment without histology is not appropriate.
Option by option
A. Radical prostatectomy without tissue diagnosis
Surgery needs histology first.
B. Multiparametric MRI followed by targeted biopsy (correct)
Correct. MRI-guided biopsy is the modern pathway.
C. Repeat PSA in 1 year
Waiting a year is unsafe with this PSA.
D. Immediate androgen deprivation
ADT needs tissue diagnosis.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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