Prostate cancer (suspected/confirmed)
Prostate cancer (suspected/confirmed) – Adult
Emergency and immediate referrals
Referral to Emergency Department
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:
Immediately contact the on-call registrar or service to arrange an immediate urology assessment (seen within 7 days) for:
- Very high PSA and confirmed malignancy
To contact the relevant service, please see HealthPathways: Acute Urology Assessment
| Presenting issues |
- Any patient with a PSA > 10ng/mL with no symptoms of prostatitis, UTI or benign prostatic hypertrophy (with a repeat PSA and MSU within four (4) weeks)
- In a person aged less than 70 years:
- at least two prostate specific antigen (PSA) tests performed within an interval of 1-3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml
- whose risk of developing prostate cancer based on family history is at least double the average risk*, at least two PSA tests performed within an interval of 1-3 months are greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%
- In a person aged 70 years or older:
- at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%
- palpable or suspicious nodule on digital rectal examination
- suspicion of metastatic diseases ie: bone pain which may or may not be confirmed on imaging such as a bone scan plain x-ray (sclerotic lesion).
*Father or brother have ever been diagnosed with prostate cancer doubles the average risk; two or more close male relatives who have been diagnosed, lifetime risk increases five-fold. Risk also increases if strong family history of breast or ovarian cancer, especially if a BRCA1 or 2 gene mutation involved (Prostate Cancer Foundation of Australia).
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| Mandatory referral information (referral will be returned if this information is not included) |
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Investigations
- PSA result(s) of concern and any previous PSA results to allow PSA acceleration to be assessed
- MSU or CSU M/C/S
If unable to attach reports, please include relevant information/findings in the body of the referral
Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)
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| Highly desirable referral information |
- Urinary tract USS +/- post void residual
- Digital rectal examination findings
- Free to Total PSA ratio
- FBC including fasting BGL/HbA1c
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Indicative triage category
| Indicative triage category |
Category 1
Appointment within 30 days |
- PSA > 10ng/ml
- Radiological imaging indicative of ureteric obstruction
- Palpable or suspicious nodule on DRE
- Bone pain in the presence of raised PSA level
- Evidence of metastases (NB: Medical Oncology will usually require a biopsy prior to treatment so refer Urology first)
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Category 2
Appointment within 90 days |
In a person aged less than 70 years:
- at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months are greater than 3.0 ng/ml, and the free/total PSA ratio is less than 25% or the repeat PSA exceeds 5.5 ng/ml
- whose risk of developing prostate cancer based on family history is at least double the average risk, at least two PSA tests performed within an interval of 1- 3 months are greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%
In a person aged 70 years or older:
- at least two PSA tests performed within an interval of 1- 3 months are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%
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Category 3
Appointment within 365 days |
- No defined category 3 criteria
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Last reviewed: 05-01-2024