Prostate cancer (suspected) Referral Access Criteria

• Nil

• A single PSA test ≥50ng/ml

• Concerning prostate specific antigen (PSA) trend (≥0.75ng/ml/year)
• In a person aged ≥70 years:
  
  • Has at least two PSA tests performed within an interval of 1-3 months that are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%
• In a person aged <70 years:
  
  • Has at least two PSA tests performed within an interval of 1-3 months that are greater than 3.0ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5ng/ml
  • With relevant family history, has at least two PSA tests performed within an interval of 1-3 months have a PSA concentration greater than 2.0 ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5ng/ml
• Palpable (hard), asymmetrical, or suspicious nodule on digital rectal examination (DRE)
• Imaging suggestive of prostate cancer

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Current medication list
• Any known allergies
• Whether presence of lower urinary tract symptoms

• Nil

• At least two tests demonstrating an elevated PSA performed 1-3 months apart, with a free/total ratio added to the follow up PSA
  And/or
• If referral is for DRE suspicious of malignancy: Digital rectal examination findings and at least one elevated PSA  
  And/or
• If found on imaging: attach relevant reports e.g. transrectal ultrasound (US), or MRI, or PET

• Whether symptoms of advanced malignancy are present (e.g. unexplained weight loss, anorexia, bone pain or pathological features)
• Family history of prostate cancer
• Details of any previous prostate surgery

• Nil

• MSU (or CSU) MCS
• FBC
• U&E
• Digital rectal examination findings
• Renal tract ultrasound (US)

Category 1

Appointment within 30 days

• PSA consistently ≥10ng/ml as evidenced by two successive PSA tests at least 1 month apart 
• Hydronephrosis with an elevated PSA
• Palpable or suspicious nodule on digital rectal examination
• Bone pain with an elevated PSA          

Category 2

Appointment within 90 days

• In a person aged ≥70 years:
  • Has at least two PSA tests performed within an interval of 1- 3 months that are greater than 5.5ng/ml and the free/total PSA ratio is less than 25%
• In a person aged <70 years: 
  • Has at least two prostate specific antigen (PSA) tests performed within an interval of 1- 3 months that are greater than 3.0ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5ng/ml
  • With relevant family history, has at least two PSA tests performed within an interval of 1-3 months have a PSA concentration greater than 2.0ng/ml, and the free/total PSA ratio is less than 25%, or the repeat PSA exceeds 5.5ng/ml

Category 3

Appointment within 365 days

• No defined category 3 criteria 

• Nil

• Each PSA test should be from the same lab. 
• A single test PSA >10ng/ml can occur with inflammation but does not necessarily require a specialist referral yet. A follow up PSA test should be repeated in 4 weeks. 
• If the first PSA test is elevated but the follow-up PSA test is not, a specialist referral is not required. The patient can be managed in primary care with annual monitoring. 
• Consider and excluded other causes of elevated PSA (e.g. urinary tract infection or prostatitis) before specialist referral. 
• Short-lived (48 hours) increases in PSA can occur with cycling, heavy exercise, and ejaculation. 
• Relevant family history is a first degree relative with or has had prostate cancer or suspected of carrying a BRCA 1 or BRCA 2 mutation.