Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • renal failure from ureteric or bladder outflow obstruction
  • severe bone pain related to metastasis
  • suspected cauda equina syndrome
  • suspected spinal cord compression
  • urinary retention

Please contact the urology registrar on call to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

National Continence Helpline

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • asymptomatic men with normal:
    • age-related prostate-specific antigen (PSA) and
    • digital rectal examination (DRE)
  • erectile dysfunction unrelated to surgical treatment for prostate or colorectal cancer
  • patients who have been fully investigated within the previous 12 months with negative results

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • concerning features on imaging suspicious of malignancy e.g. prostate imaging–reporting and data system
  • asymptomatic male with PSA greater than 10ng/ml above age related range
  • rectal examination findings suspicious of malignancy with or without elevated PSA

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic male with PSA less than 10ng/ml above age related range
  • risk factors for prostate cancer including family history of prostate cancer without an elevated PSA

Category 3 (appointment clinically indicated within 365 days)

  • nil

For more on outpatient referrals, see the general referral information page.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander
  • identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • relevant past medical/surgical history
  • family history of prostate cancer
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
  • international prostate symptom score (IPSS)
  • physical examination findings
    • abdominal examination e.g. palpable bladder
    • digital rectal exam
    • neurological examination, exclude spinal cord compression
  • relevant diagnostic/imaging reports, including location of company and accession number
  • if prostate-specific antigen (PSA) greater than 20 consider:
    • chest-abdomen-pelvis (CAP) staging CT with contrast
    • whole body bone scan

Pathology

Additional information to assist triage categorisation

  • PSA history/trends if available

Clinical management advice

Patient compliance is required for at least two PSA tests, conducted 4-6 weeks apart, with the following guidelines:

  • no sexual activity for 5 to 7 days before testing
  • no cycling
  • no direct rectal examination (DRE) for 5 to 7 days before testing

PSA testing should not be conducted when a urinary tract infection (UTI) is present or if there has been instrumentation/insertion of an inner dwelling catheter (IDC).

Clinical resources

Consumer resources