Link to SGHD referral guidelines (Urological Cancers (scot.nhs.uk) and Scottish Access Collaborative haematuria consensus report (National Urology Referral and Management Pathways Visible Haematuria Non-Visible Haematuria (revised August 2021) | Turas | Learn (nhs.scot)

• Evidence from digital rectal examination (DRE) of a hard, irregular prostate
• Elevated or rising age specific prostate specific antigen (PSA) on two samples at least six weeks apart. Rough guide to low risk PSA levels (ng/mL):
  • Aged 40-49 >2.0
  • Aged 50-59 >3.0
  • Aged 60-69 >4.0
  • Aged 70-80 >5.0
  • Aged 81 and over >20.0
• In men older than 80, or younger men with significant frailty or co-morbidity, the principles of realistic medicine would apply and we would be unlikely to pursue early or localised disease such as a small nodule on DRE alone or elevated PSA.
• In this situation, a single PSA of 20 or above, rapidly rising PSA without other precipitant or concern over potential metastatic disease would be appropriate triggers for a USC referral. (Advice available via Clinical Dialogue if unsure)

• This can be associated with prostate and testicular cancer and should be referred as USC if examination is abnormal and/or PSA is raised (see rough guide to PSA limits)
  • If examination is normal and PSA is within normal limits consider routine referral

• Aged 45 and over and have:
  • Unexplained visible haematuria without urinary tract infection
  • Visible haematuria that persists or recurs after successful treatment of UTI
• Aged 60 and over and have unexplained non-visible haematuria
  • Repeat urine dipstick between 2 and 6 weeks. If on repeat >1+ blood then refer as USC. If negative or trace on repeat then non referral required.
• Abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract

• These lesions are difficult to characterise with cross sectional imaging due to their size
• They do not require a USC referral
• Annual USS should be performed and if it increases in size or changes in nature please refer as USC at this point

• Non painful enlargement or change in shape or texture of the body of the testis
• Suspicious scrotal mass found on imaging
• Men considered to have epididymo-orchitis or orchitis which is not responding to treatment
• Any non-healing lesion on the penis or painful phimosis