Suspected Cancer: 2 Week Wait

Suspected Site: Prostate
For all suspected prostate cancers, please enclose the latest Prostate-Specific Antigen (PSA) test result.

  • Prostate feels malignant (firm, hard, nodular or craggy) on DRE.
  • Symptomatic patient with a PSA >20ng/mL  - no need to repeat test.
  • Where the initial PSA result is <20ng/mL, a repeat test should be obtained at least 4 weeks later.
  • Symptomatic patients: PSA test requires two blood tests, at least 4 weeks apart, excluding UTI and leaving >6 weeks after treating a proven UTI before repeating PSA.
  • Refer if both PSAs are above NICE-specified levels for age: 
    Age-specific PSA thresholds for people with possible symptoms of prostate cancer.
    • Below 40: Use clinical judgement
    • 40–49: More than 2.5
    • 50–59: More than 3.5
    • 60–69: More than 4.5
    • 70–79: More than 6.5
    • Above 79: Use clinical judgement
      Further info available here:
NICE - How should I assess a person with suspected prostate cancer?
  • Note: Please double the PSA rest result if patient has been taking Finasteride or Dutasteride for more than 6 months.  
  • For raised PSA in men with significant co-morbidities, performance status >3 or life expectancy <10 years, consider discussion with patient/family/carers and/or a specialist before urgent referral.
  • CRH Referrals only: 
    In asymptomatic men requesting PSA testing between the ages of 50-69, use a PSA threshold of </=3ng/ml on 2 interval samples as per Prostate Cancer Risk Management Programme.
  • Informed consent: please provide patients with patient information.

Suspected Site: Bladder & Kidney
Male Patients: please enclose recent PSA result and Urea & Electrolytes (U&E) results.
Female Patients: please enclose recent U&Es.

  • Patients ≥45 years with visible haematuria (VH) which is unexplained or persists/recurs after treatment of UTI (please enclose PSA results in male patients). 
  • Patients ≥60 years with unexplained non-visible haematuria (NVH) and either dysuria or a raised serum white cell count (please ensure NVH confirmed on 2 or more dipstick tests. Note: trace = negative).

Suspected Site: Testis

  • Hard swelling in the body of the testis (refer immediately, check LDH, alpha-fetoprotein and beta-HCG).
  • Radiological suspicion of testis cancer (enclose imaging report, check LDH, alpha-fetoprotein and beta-HCG).  
  • Radiological imaging suspicious for kidney/bladder malignancy (please enclose imaging report).

Suspected Site: Penis

  • Penile mass or ulcerated lesion in the absence of sexually-transmitted infection (STI) or after STI treatment has been completed.
Cancer Less Likely

Suspected Site: Bladder & Kidney

  • Consider non-urgent referral for patients <45 years with VH which is unexplained or persists/recurs after treatment of UTI.
  • Consider non-urgent referral for those ≥60 years with either persistent NVH or recurrent/persistent UTI.

Significant Weight Loss Only?

Non Site-Specific Pathway