Urology referral criteria (Guidelines)



  • Highland HSCP

Prostate cancer

  • 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

Bladder and kidney cancer

  • 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

Sub-centimetre renal lesions

  • 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

Testicular and other

  • 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

Editorial Information

Last reviewed: 30/01/2024

Next review date: 31/01/2027

Author(s): Urology Department .

Version: 1.2

Reviewer name(s): Dr I Wilson, Consultant Urologist .

Document Id: TAM420