Urology: androgen deprivation therapy: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: androgen deprivation therapy

Sample item

A 70-year-old man with metastatic prostate cancer and bone pain is to start a GnRH agonist, leuprolide. What should be added at the start to prevent a tumour flare?

AIntravenous zoledronic acidBOral dexamethasone aloneCA 5-alpha reductase inhibitor such as finasterideDAn oral anti-androgen such as bicalutamide

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. An oral anti-androgen such as bicalutamide

A GnRH agonist initially stimulates LH release before pituitary desensitisation, causing a transient testosterone rise for 1 to 2 weeks. In metastatic disease this flare can worsen bone pain, urinary obstruction or cord compression. An anti-androgen started before and continued for the first weeks blocks the receptor and prevents flare.

Option by option

A. Intravenous zoledronic acid
Zoledronic acid reduces skeletal events but does not prevent hormonal flare.
B. Oral dexamethasone alone
A corticosteroid does not block the androgen surge.
C. A 5-alpha reductase inhibitor such as finasteride
Finasteride lowers dihydrotestosterone but does not prevent flare, and is used for BPH.
D. An oral anti-androgen such as bicalutamide (correct)
Receptor blockade prevents the testosterone surge from stimulating tumour cells.

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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, An oral anti-androgen such as bicalutamide. A GnRH agonist initially stimulates LH release before pituitary desensitisation, causing a transient testosterone rise for 1 to 2 weeks.

Why is "Intravenous zoledronic acid" not the answer?

Zoledronic acid reduces skeletal events but does not prevent hormonal flare.

Why is "Oral dexamethasone alone" not the answer?

A corticosteroid does not block the androgen surge.

Why is "A 5-alpha reductase inhibitor such as finasteride" not the answer?

Finasteride lowers dihydrotestosterone but does not prevent flare, and is used for BPH.

What concept does this question test?

It tests Urology: androgen deprivation therapy in General Surgery. In metastatic disease this flare can worsen bone pain, urinary obstruction or cord compression. An anti-androgen started before and continued for the first weeks blocks the receptor and prevents flare.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: androgen deprivation therapy?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.