How should I assess a patient with elevated PSA levels for potential prostate cancer referral?

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 ².

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 ¹,².

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 ¹,².

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 ².