Tag: penile

Urology, Suspicion of Cancer Referral

Scott McLaughlin
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.

Urgent suspicion of cancer referral

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

Urology Cancer Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main Presenting Complaint: [Text – 98 character maximum]

Reason for Referral: [Text]

World Health Organisation Performance Scale
Using the following as a guide, please select the most appropriate answer to describe the patients general health:

Options:

  • Asymptomatic
  • Symptomatic but completely ambulatory
  • Symptomatic, <50% in bed during the day
  • Symptomatic, >50% in bed, but not bedbound
  • Bedbound

Priority: Urgent Suspicion of Cancer

Date of Onset: [Date]

Prefered Hospital:

  • Hairmyres Hospital
  • Monklands Hospital
  • Wishaw General Hospital
  • First Available appointment

Clinical Examinations and Findings

Examinations and Findings

Frank haematuria in an adult (unexplained):

  • Yes (If Yes, please provide brief details)
  • No

Symptomatic, non-visible haematuria in a patient over 40 years old:

  • Yes (If Yes, please provide brief details)
  • No

Palpable renal mass with/without pain, with/without haematuria:

  • Yes (If Yes, please provide brief details)
  • No

Solid renal mass found on imaging:

  • Yes (If Yes, please provide brief details)
  • No

PSA outwith age related reference range:

  • Yes (If Yes, please provide brief details)
  • No

Clinically malignant prostate on PR exam and/or bone pain suspicious of metatastic prostate cancer:

  • Yes (If Yes, please provide brief details)
  • No

Swelling in body of testis or other suspicion of testis cancer:

  • Yes (If Yes, please provide brief details)
  • No

Suspected penile cancer:

  • Yes (If Yes, please provide brief details)
  • No

Investigations

Please indicate if any of these tests have been checked.

MSSU:

  • Yes
  • No

U&E and FBC:

  • Yes
  • No

PSA – after patient has been counselled:

  • Yes
  • No

Urology cancer guideline