Urological cancers
Prostate cancer
Prostate cancer is the most common cancer in males in Scotland, with approximately 2,800 new cases diagnosed every year. Risk increases with age and approximately 99% of cases are diagnosed in men aged over 50 years. Men are 2.5 times more likely to be diagnosed with prostate cancer, if their father or brother has had it. In the UK, the lifetime risk of prostate cancer in Black men (1 in 4) is double that of the lifetime risk of all men combined (1 in 8).
Men presenting with unexplained possible symptoms and signs suggestive of prostate cancer such as changes to urinary patterns, erectile dysfunction, haematuria, lower back pain, bone pain or weight loss should have a digital rectal examination and a prostate specific antigen (PSA) test with counselling. A PSA test should not be performed within 1 month of a proven urinary tract infection (UTI). It should be noted that the majority of men with prostate cancer have no symptoms at all.
Bladder and kidney cancer
Visible haematuria is the most common presenting symptom for both bladder and kidney cancer. Other presenting features include loin pain, renal masses, non-visible haematuria, anaemia, weight loss and pyrexia. Both cancers are uncommon, with around 800 new bladder and 860 new kidney cancers each year.
Testicular and penile cancer
Although scrotal swellings are a common presentation in general practice, testicular cancer is relatively rare, with around 200 new cases per annum, of which approximately 70% are between 15 and 45 years. Solid swellings affecting the body of the testis have a high probability (>50%) of being due to cancer. Cancer of the penis is rare, with around 60 new cases each year in Scotland, but its incidence is rising.
All patients presenting with symptoms or signs suggestive of urological cancer should be referred to a team specialising in the management of urological cancer, depending on local arrangements.
Prostate cancer
Evidence from digital rectal examination of a hard, irregular prostate
Elevated or rising age-specific PSA. Rough guide to normal PSA levels:
- men less than 60 years – less than 3ng/ml
- men aged 60 – 69 years – less than 4ng/ml
- men aged 70 years and over – less than 5ng/ml
Bladder and kidney cancer
- Patients with painless visible haematuria
- Patients with non-visible haematuria and symptoms suggestive of UTI but with sterile mid-stream urine (MSU)
- Abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract
Testicular and penile cancer
- Swelling in 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
Non urgent referral
- Elevated age-specific PSA where urgent referral will not affect outcome due to age or comorbidity
- Asymptomatic persistent non-visible haematuria without obvious cause
- Patients over 40 who present with recurrent UTI associated with any haematuria
Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 85 – Management of transitional cell carcinoma of the bladder
Clinical Lead: Mr Rehan Khan, Consultant Urology Surgeon, NHS Lanarkshire
Review Date April 2017