Prostate cancer (suspected/confirmed) Referral Access Criteria

Referrers should use this page when referring patients to public adult urology outpatient services for prostate cancer (suspected or confirmed).

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Nil

Immediate referral
Immediately contact on-call registrar or service to arrange immediate urology assessment (seen within 7 days):
Very high PSA and confirmed malignancy To contact the relevant service, see Clinician Assist WA: Acute Urology Assessment (external site)

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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).

Clinical indications for outpatient referral

If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

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).

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason). 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.
History	Nil
Examination	Nil
Investigations	PSA result(s) of concern and any previous PSA results to allow PSA acceleration to be assessed MSU or CSU M/C/S

Highly desirable
History	Nil
Examination	Nil
Investigations	Urinary tract USS +/- post void residual Digital rectal examination findings Free to total PSA ratio FBC including fasting BGL/HbA1c

Indicative clinical urgency 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)
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%
Category 3 Appointment within 365 days	No defined category 3 criteria

Indicative clinical urgency 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)

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%

Category 3

Appointment within 365 days

No defined category 3 criteria

Exclusions
Nil

Useful information
Nil

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Last reviewed: 05-01-2024

Prostate cancer (suspected/confirmed) Referral Access Criteria

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