Shaping better health
REMEDY : BNSSG referral pathways

Prostate - PSA

Checked: 24-01-2017 by (LEFT) christopher.moloney Next Review: 28-12-2018

Raised PSA

If an asymptomatic man asks for PSA screening then explain PSA is not a recognised screen for prostate cancer (sensitivity 80%, specificity 40-50%).  If elevated then prostate biopsy is diagnostic test but has risks (>1% risk of infection, 1% risk of significant bleeding) and still only picks up 70-80% of cancers.  Therefore ask patient if they are willing to undergo prostate biopsy before testing PSA.

If age >80 and less than 10 year life expectancy then do not do PSA unless patient is symptomatic of suspected malignancy and a diagnosis will change management.

If age 40-49 and family history of prostate cancer then consider PSA at patient request if patient willing to undergo further investigations.

Referral Guidance

See local guidelines for suspected urological cancer

Refer according to PSA level when;

Age 50-59 >3.0
Age 60-69 >4.0
Age >70 > 5.0

Refer all patients with abnormal prostate on DRE (other than benign feeling enlargement).


Red Flags

Refer all age specific raised PSA for investigation (according to 2WW guidelines).  Do not monitor in surgery without a urological opinion.

Useful Links

CKS Guidelines for Management of Acute Prostatitis (web page)
CKS Guidelines for Management of Chronic Prostatitis (web page)