To assess a patient with elevated prostate-specific antigen (PSA) levels for potential prostate cancer diagnosis, first consider the patient's age-specific PSA threshold. Refer men using a suspected cancer pathway referral (appointment within 2 weeks) if their PSA level is above the age-specific reference range: more than 2.5 µg/L for ages 40-49, more than 3.5 µg/L for ages 50-59, more than 4.5 µg/L for ages 60-69, and more than 6.5 µg/L for ages 70-79. Use clinical judgement for those below 40 or above 79 years NICE NG12.
Additionally, perform a digital rectal examination (DRE) to assess the prostate. If the prostate feels malignant on DRE, refer urgently via the suspected cancer pathway regardless of PSA level NICE CKS,NICE NG12.
Consider PSA testing and DRE in men presenting with any lower urinary tract symptoms (such as nocturia, urinary frequency, hesitancy, urgency, or retention), erectile dysfunction, or visible haematuria NICE CKS,NICE NG12.
When PSA is elevated above the age-specific threshold and/or the prostate feels malignant on DRE, refer the patient urgently for specialist assessment to exclude prostate cancer, taking into account the patient's preferences and comorbidities NICE NG12.