Urological Cancers

Urgent suspicion of cancer referral

Prostate cancer:

  • Evidence from digital rectal examination of a hard, irregular prostate
  • Elevated or rising age-specific PSA. Rough guide to normal PSA levels (ng/ml):
    • Less than 60 years < 3
    • Aged 60-69 years < 4
    • Aged 70-79 years < 5

These figures are a pragmatic aid based on clinical consensus. The principles of Realistic Medicine should be applied when considering referral and, in older men, routine or no referral may be appropriate for PSA levels of:

  • Aged 80-85 years > 10
  • Aged 86 years and over > 20

Bladder and kidney cancer:

  • Aged 45 and over and have unexplained visible haematuria without urinary tract infection
  • Visible haematuria that persists or recurs after successful treatment of urinary tract infection
  • Aged 60 and over and have persistent unexplained non-visible haematuria in the absence of urinary infection
  • Abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract

Testicular and penile cancer

  • Non painful enlargement or change in shape or texture of the body of the testis
  • Suspicious scrotal mass found on imaging
  • Men considered to have epididymo-orchitis or orchitis which is not responding to treatment
  • Any non-healing lesion on the penis or painful phimosis

Routine Referral

  • Elevated age-specific PSA where urgent referral will not affect outcome due to age or comorbidity
  • Asymptomatic persistent non-visible haematuria without obvious cause (age 45 – 60)
  • Unexplained visible haematuria < 45 years of age 
  • Patients over 40 who present with recurrent UTI associated with any haematuria
Full Guideline