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This guidance covers the referral of a patient who presents with symptoms or signs suggestive of a urological cancer to a team specialising in the management of urological cancer, depending on local arrangements.
GPs can refer a patient they suspect of having cancer to be seen within 14 days by a specialist. GPs must send the referral within 24 hours of the decision to refer.
Please use the referral forms listed on this page to ensure appropriateness. They have been agreed by the Peninsula Cancer Network.
In an asymptomatic male with a borderline level of PSA, repeat the PSA test after 1 to 3 months. If the PSA level is rising, refer the patient urgently.
A digital rectal examination and a PSA test (after counselling) are recommended for patients with any of the following unexplained symptoms:
Exclude urinary infection before PSA testing. Postpone the PSA test for at least 1 month after treatment of a proven urinary infection.
In male or female patients with symptoms suggestive of a urinary infection and macroscopic haematuria, diagnose and treat the infection before considering referral. If infection is not confirmed, refer them urgently.
Consider an urgent ultrasound in men with a scrotal mass that does not transilluminate and/or when the body of the testis cannot be distinguished.
Age specific PSA abnormal range (from Macmillan referral guidance):
Consider alternative contributing factors that may influence an individual's PSA ranges.
The PSA test should be postponed for at least 1 month after treatment of a UTI.
In patients with a borderline raised PSA, repeat the PSA after 1 month and refer as a fast track if the second PSA has risen.
In patients compromised by co-morbidities or with a below 10 year life-expectancy, a discussion with the patient or carers and/or urologist may be more appropriate.
Risks of cancer less than 10% when PSA is within normal range, 20% when PSA 4-10 ng/ml, 30% if more than 10ng/ml and 50% if more than 20ng/ml.
Bladder and Renal cancer
Aged 45 and over and have:
Visible haematuria that persists or recurs after successful treatment of urinary tract infection
Aged 60 and over and have:
Menstruating females may have non-visible haematuria for 3 days prior to and 5 days post menstruation. Non-visible haematuria may also be present for 3 days post intercourse. Please exclude these prior to referral
Aged 60 and over and have:
Unexplained non-visible haematuria with a raised white cell count on a blood test.
A soft tissue mass identified on imaging thought to arise from the urinary tract.
A persistent penile lesion after treatment for a sexually transmitted infection has been completed.
Unexplained or persistent symptoms affecting the foreskin or glans (consider). This does not include simple phimosis, fungal infections and balanoposthitis.
The GP should use e-Referral Service to book an appointment or send the referral.
Please ensure you include:
Please ensure that referrals are booked via NHS e-Referral Service. If no slots are available please defer to provider and the RDE will book the appointment and contact the patient. Please also ensure that referral letters are attached to the system within 24 hours to enable us to book pre appointment tests and scans timely.
This guideline has been signed off by NEW Devon CCG.
Publication date: November 2016