NICE have recently amended their guidance with regard to referral thresholds for abnormal PSA.

Old NICE guidance said to refer asymptomatic patients depending upon their age-related PSA (50-59 ≥ 3, 60-69 ≥ 4).  The new guidance says to refer asymptomatic patients of any age if PSA ≥ 3.

This is a small change, but would increase the number of referrals to urology, and also the number of investigations which would subsequently be carried out.  East Midlands Cancer Alliance (EMCA) have debated this change and have decided to keep local guidance the same as the old NICE guidance, and labs will continue to report normal ranges depending upon age-related PSA.

If you see an asymptomatic patient and PSA ≥ 3 you can refer at any age, but it would be best practice to discuss the risks and benefits of further investigation before making the referral.  A more pragmatic approach may be to repeat PSA after three to six months to identify trend in PSA.

Symptomatic patients, with haematuria or suspicious feeling prostate on DRE, should be offered referral irrespective of PSA result.