PSA request
Asymptomatic >50yr
FH
Ethnic origin
Reason for request
LUTS
ED
Limits to PSA test
Raised 75% no cancer
Normal 15% cancer
Raised UTI ejaculation prostatic exercise
Repeat
Refer MRI Biopsy
Need > 6 weeks after Tx UTI
if > 80years
—Only perform PSA if features suggestive metastatic cancer, bone pain, weight loss, unexplained anaemia
—If patient wants PSA= shared decision making
No screening test for prostate cancer
asymptomatic men can be offered PSA but need to be aware of limitations
—If “normal” and asymptomatic do not repeat for 12 months
LUTS red flags
Weight loss
Frank haematuria
Abnormal prostate of DRE
raised PSA
“bone pain”
Prostate cancer referral USoC
PSA >3 (<70yrs), PSA >5 (70-79), PSA > 20 (80+ and good practice)
DRE suspicious
If PSA raised but ?UTI tx and repeat at 6 weeks
prostate cancer symptoms
asymptomatic
LUTs
Advanced disease; back pain, bone pain, fatigue weight loss. Spinal cord compression.
Men > 50 years or >45yr + FH (first degree relative)/ Black/mixed/ carry BRCA
-offer PSA and DRE if following symptoms
—Urgency, hesitancy, frequency, nocturia, retention
—Unexplained visible haematuria
—Haematospermia
—Erectile dysfunction
USoC Bladder cancer
Unexplained visible haematuria
—-<45 years, more than one episode- no UTI
—-<45 years and recurs/ persists after UTI Tx
—->45 years single episode without UTI
—>45 years recurs/ persists after UTI
Unexplained NON-visible haematuria
—Age > 60yrs; —persistent blood on repeat urine dip 2-6 wk apart, negative culture
—Abdominal mass on imaging ? rom renal tract.
Bladder cancer symptoms
Visible haematuria - most common
loin pain
renal mass
persistent non-visible haematuria
Anaemia
weight loss
pyrexia
Online risk calculator for bladder cancer
Always send MSU if blood on dip
-Beware the older woman with recurrent UTI
5% men >60 yr with low MCV and abdo pain have kidney cancer
Risk factors- male, smoker, FH
testicular cancer USoC referral
non painful enlargement Or change in shape\texture of testis
Epididymo-orchiditis > Not improve @ 2 weeks
USS =) Cancer
Symptoms testicular Cancer
swelling\lump testis or Scrotom
dull ache dull ache in abdo\groin
Swelling 50% chance cancer
can progress rapidly
70% men 15- 45 years
Penile cancer US( >Referral
Bleeding\persistent discharge from fore skin
Penile mass lulcer > NOT STI
persistent lesion after tx
ST should be excluded
Penile cancer Symptoms
irritation swelling - head of peris
Thickened skin foreskin penis
change in skin colour
lumps or sures which bleed
Discharge or bleeding from foreskin
