Raised PSA

• Symptomatic or patient request
  • >50 years
  • >45 years if 1 or more risk factor*

*Risk factors:

• Father/brother with prostate cancer
• Black or mixed black ethnicity
• BRCA gene variant

• LUTS
• Haematospermia
• Visible haematuria
• Erectile dysfunction
• Red flag symptoms (see below)

• Consider benign causes of raised PSA (recent UTI, prostatitis, urinary retention, instrumentation of urinary tract)
• UTI does not need to be excluded if no clinical features of infection
• If suspected exacerbating cause, repeat PSA in 6 weeks to assess trend, if still raised, refer as USOC

• Treatment of suspected underlying cause of raised PSA
• If patient requests PSA test, advise them of the advantages and disadvantages (see PSA advice)
• If normal PSA/DRE but troublesome LUTS, see Male LUTS
• Use clinical judgement in those >80 where PSA testing may be inappropriate unless:
  • symptoms suggest metastatic disease
  • or patient has 10 year life expectancy

• If PSA is elevated and patient fit, patient is likely to be vetted straight to MRI (please include in referral any contraindications to MRI)
• If equivocal fitness or grossly abnormal DRE, patient is likely to be seen urgently in clinic first

• Elevated age-related PSA:
  • <70 years: ≥ 3ng/ml
  • 70-79 years: ≥5 ng/ml
  • 80 and above years: ≥ 20ng/ml

• A DRE suspicious of prostate cancer (hard and/or irregular) – request an urgent PSA test in parallel

• BRCA, breast cancer gene
• DRE, digital rectal examination
• LUTS, lower urinary tract symptoms
• MSSU, midstream specimen of urine
• MRI, magnetic resonance imaging
• PIL, patient information leaflet
• PSA, prostate-specific antigen
• UTI, urinary tract infection

CfSD. Scottish Referral Guidelines for Suspected Cancer 2024 Full Clinical Review (Draft). December 2024.