Guidance for referring patients for suspected prostate cancer

In summary:

• GPs should continue to refer men with suspected prostate cancer on the current urgent suspected cancer (USC) form
• GPs should undertake prostate-specific antigen (PSA) testing in symptomatic patients in line with NICE guidelines (new lower urinary tract symptoms, visible haematuria, unexplained non-visible haematuria with dysuria or raised WCC on blood test)
• GPs should continue to undertake PSA testing in asymptomatic patients following GIRFT guidelines

 
GIRFT guidelines summary

• when the PSA is raised, use a urine test to exclude infection
• no digital rectal examination is needed if the PSA is raised
• if DRE has been done, and is abnormal, refer to secondary care, even if the PSA is within normal limits
• there is no need to repeat a raised PSA unless there are other probable causes of a raised PSA, for example a urinary tract infection or recent catheterisation
• patients with a PSA > 20ng/ml should always be referred regardless of other potential causes
• do not routinely test PSA in asymptomatic patients aged over 80 years or co-morbid patients
• GPs should take the opportunity to discuss the need for men to attend secondary care for their investigations and to address/reassure them regarding any concerns they may have
• GP should share film link: What to expect from your prostate clinic referral 

Primary Care Prostate Cancer LCS

For full details of the Primary Care Prostate Cancer Locally Commissioned Service (LCS), visit the LCS page.