• Dr Simon Moore MD CCFP

Urgent or elective? Four things to know about the new Prostate Referral guidelines

What do you do for a patient with a prostate nodule? What if his PSA is reassuringly low? Should you even order a PSA in the first place?

This year, the Canadian Family Physician journal published 2015 referral guidelines on suspected prostate cancer.

Four things to know from these new guidelines:

1. Remember the 10-20 rule. That's the PSA cutoff for low, medium, and high risk for requiring nonurgent, semiurgent (10-20), and urgent (>20) referral.

2. The above rule doesn’t apply if the patient has prostate findings. All patients with hard or irregular prostate on DRE need to see a urologist; the question is how soon. For patients with prostate findings, the cutoff is 10; below that, nonurgent referral; above that, urgent referral.

3. Ask about suspicious symptoms! Red flags include:

- Low back pain, especially when reproducible by percussion - Severe bone pain - Weight loss

Even if their PSA is low risk (remember that’s < 10), and DRE are normal, a patient with these symptoms should be referred. . 4. Think “What else could it be?” Before thinking cancer, be sure to make sure your patient’s elevated PSA isn’t due to:

- BPH - Infection i.e. Urethritis, cystitis - Inflammation - Prostatitis - Recent sexual activity - Recent DRE (though this doesn’t increase the PSA enough to change management, so go ahead and do the DRE before the patient gets their labs done)

Note this guideline does NOT cover screening - and for that you should be very familiar with the current and controversial Canadian guidelines on prostate cancer screening using PSA, available at the CTFPHC - we’ll be sure to discuss this guideline, and review all of the 99 topics at the review course.

Highly Rated - Thousands of Attendees
  • Facebook
  • Twitter
  • Instagram

© The Review Course in Family Medicine Inc. | About Us | Privacy Policy

The only Canada-Wide CCFP exam course - created by two Family Doctors who wished this existed when we were residents, and are on a mission to help CCFP exam candidates. Disclosures: The Review Course founders have no conflicting commercial interests. As is the case with any private events hosted on a university campus or hospital, this event is not affiliated with nor endorsed by the host venues. Our materials are peer-reviewed and prepared by Canadian physicians; we do not guarantee that our preparation materials are representative of any Canadian examination and we do not provide questions from any other examination nor are they intended as medical advice. The College of Family Physicians of Canada does not affiliate with nor endorse any exam preparation course.