When should I refer a patient with elevated PSA levels for urological assessment?

Refer a patient with elevated prostate-specific antigen (PSA) levels for urological assessment if their PSA level is above the age-specific threshold and they have possible symptoms of prostate cancer.

Age-specific PSA thresholds for referral are:

• 40 to 49 years: PSA > 2.5 micrograms/litre
• 50 to 59 years: PSA > 3.5 micrograms/litre
• 60 to 69 years: PSA > 4.5 micrograms/litre
• 70 to 79 years: PSA > 6.5 micrograms/litre

For patients below 40 or above 79 years, use clinical judgement.

Referral should be made using a suspected cancer pathway if the PSA is above these thresholds, taking into account the patient's preferences and comorbidities.

Additionally, refer immediately if the prostate feels malignant on digital rectal examination regardless of PSA level.