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Should I see a prostate cancer specialist?

Men and women discussing prostate cancer

This page tells you about UK guidelines for seeing a prostate cancer specialist. There is information about

 

A quick guide to what's on this page

Should I see a prostate cancer specialist?

The symptoms of prostate cancer can be very similar to some other prostate conditions. So it can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. The National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs in the UK. The guidelines help GPs decide which patients need to be seen urgently by a specialist called a urologist.

It is important when reading these guidelines to remember that 99% of men diagnosed with prostate cancer are over 50. And 75% are over 70.

The guidelines say you should ideally get an appointment within 2 weeks (an urgent referral) if you have

  • Abnormalities in your prostate that your GP can feel during a rectal examination
  • A prostate specific antigen (PSA) test that is considered high for your age
  • A borderline PSA test, followed by a repeat test 1 to 3 months later that shows the level is rising
  • A raised PSA reading, together with other symptoms that may be linked to prostate cancer

If you have symptoms and you don't think your GP is taking them seriously enough, you could print off this page and take it to your appointment. You may be able to decide together whether you need to see a specialist and how soon.

 

CR PDF Icon You can view and print the quick guides for all the pages in the About prostate cancer section.

 

 

Referrals from your GP

The symptoms of prostate cancer can be very similar to some other prostate conditions. So it can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own.

With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to treatment such as antibiotics. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed. Then people needing urgent appointments wouldn't be able to get them.

There are particular symptoms that mean your GP should refer you to a specialist straight away. The National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs in the UK. The guidelines help GPs decide which patients need to be seen urgently by a specialist called a urologist. A urologist is a doctor who specialises in treating disorders of the urinary tract, including the bladder, kidney and prostate.

 

Points to remember about referral guidelines

While reading these guidelines, it is important to remember that

  • More than 99 out of every 100 men diagnosed with prostate cancer are over 50
  • About 75 out of every 100 men diagnosed with prostate cancer are over 70
  • Difficulty passing urine is common in the general population and on its own, is not a reason for your GP to suspect prostate cancer
  • The most common signs of prostate cancer are a raised PSA blood test and an abnormality found by your GP during an examination of your prostate (digital rectal examination)
  • A normal PSA reading varies depending on your age
  • Men with a first degree relative (mother, father, son or daughter) who have prostate or breast cancer are at a higher risk of developing prostate cancer themselves
 

PSA testing

PSA stands for prostate specific antigen. This is a substance made by normal and cancerous prostate cells and released into the bloodstream. The level of PSA in your blood may go up in prostate cancer because more PSA leaks into the bloodstream from the cancerous cells. PSA levels also go up as you get older and if you have a benign (non cancerous) enlarged prostate. So the PSA test is not a specific test for cancer. There is a range of normal PSA readings for every age group. The upper normal limit for a man aged 50 is around 3.0 ng/ml but this increases to 5.0 ng/ml if you are 70.

The UK does not have a national policy for PSA testing of all men at a certain age. There is no national screening programme in place for prostate cancer. If you don't have any symptoms of prostate cancer but still want a PSA test, speak to your GP. Your GP will need to give you information about the benefits and possible harms of the test.

 

Guidelines for urgent referral

According to the NICE guidelines, you should ideally get an appointment within 2 weeks (an urgent referral) if you have certain symptoms. The symptoms are

  • Abnormalities in your prostate that your GP can feel during a rectal examination
  • A PSA test that is considered high for your age
  • A borderline PSA test, followed by a repeat test 1 to 3 months later that shows the level is rising
  • A raised PSA reading, together with other symptoms that may be linked to prostate cancer

The symptoms that the guidelines suggest GPs should also consider are

  • Unexplained weight loss (especially if you are elderly)
  • Low back pain or other bone pain
  • Blood in the urine
  • Problems getting an erection (when you have not had problems before)

The guidelines say that your GP should offer to do a rectal examination and a PSA test if you have these symptoms.

There is information about the possible risks and causes and symptoms of prostate cancer in this section.

 

Talking to your GP

If you are worried that your GP is not taking your symptoms as seriously as you think they should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you. You may be able to decide together whether you need to see a specialist and if so, how soon.

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Updated: 20 February 2014