Raised PSA

J.B. & H.S 16-12-24

Who to refer:

Men with raised PSA according to the following age-adjusted limits:

Under 60 years ˃3

Aged 60-69 years ˃4

Aged 70 years and over ˃5

The principles of Realistic Medicine should be applied when considering referral and, in older men, routine or no referral may be appropriate for PSA levels of:

Aged 80-85 years > 10

Aged 86 years and over > 20

Before having a PSA test men should NOT have:

an active urinary infection or prostatitis
had a proven UTI within last 6 weeks
ejaculated in the previous 72 hours
exercised vigorously in the previous 48 hours
had a prostate biopsy in the previous 6 weeks

Men with an abnormal DRE

Who not to refer:

Men who have a raised PSA as a result of a suspected benign cause (see above). Where the PSA is raised in these situations, it should be repeated 4 weeks later. Referral is indicated if it remains elevated. If there is a downward trend, it can be monitored until it returns to normal.
Men with significant co-morbidities, especially those aged 75 or over, should not undergo investigations for prostate cancer without careful consideration of whether a diagnosis of prostate cancer is in their interests. Please indicate any such co-morbidities on the referral.
PSA testing in elderly men is not recommended unless a diagnosis of prostate cancer is relevant to that particular patient’s situation and will affect their management.