This page is based on the Scottish Cancer Referral Guidelines Scottish Referral Guidelines for Suspected Cancer 2025
Prostate cancer is the most common cancer among men in Scotland, accounting for around 4,700 diagnoses each year.
For further information see here. This provides detail on the following:
- Clinical features at presentation
- Risk factors for prostate cancer
- Prostate examination in transgender patients
- PSA testing and referral in older patients and those living with frailty
- PSA testing in asymptomatic patients
- How to avoid false positives when performing a PSA test
D.M. & H.S 19-02-26
Who to refer:
The following patients should be referred as Urgent Suspicion of Cancer:
Patients with raised PSA according to the following age-adjusted limits:
Under 70 ≥ 3ug/L
70-79 ≥ 5ug/L
80 and above ≥ 20ug/L
For men 80-85 who are fit and do not have multiple co-morbidities if PSA ≥10 but <20 refer to Urology as Urgent
(Be aware that 5α-Reductase Inhibitors can reduce PSA by up to 50% after 3 months and results should be adjusted accordingly)
Patients with a Digital Rectal Examination (DRE) suspicious of prostate cancer (hard and/or irregular) with any PSA.
Who not to refer:
- Men who have a raised PSA that is suspected to be spurious.
- If benign cause suspected and normal DRE – repeat PSA in 6 weeks
(If ejaculation or vigorous exercise within 48hours repeat within 2 weeks) - If remains raised Refer to Urology as Urgent Suspected Cancer
- If benign cause suspected and normal DRE – repeat PSA in 6 weeks
- Please use the principles of Realistic Medicine when testing and referring elderly and those with significant co-morbidities.
- Men with significant co-morbidities, especially those aged 80 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.
- In asymptomatic men who have a normal PSA test, this should not be repeated within 12 months.
How to refer:
- Via SCI Gateway>WGH>Urology>LI Prostate Disease
- Please check UEs at time of referral
After referral:
Suitable patients <75 will now go direct to MRI.
Please inform anyone under 75 who is being referred on the USC prostate pathway that it’s likely they will be sent directly for MRI scanning before seeing a specialist and so to expect to be contacted by telephone to arrange an appointment for an MRI scan in the first instance.
To enable the scanning to take place, please make sure an eGFR has been taken within the last 6 months if the patient is older than 65, is diabetic, or there is known/history of previous renal impairment.
If possible, please include whether patients have::
- Pacemaker/implanted cardiac device
- Electronic implant (Cochlear implant, neuro-stimulator, drug infusion pump etc)
- Metal fragments (in the eye, shrapnel, bullets etc)
- History of operations using pins, plates, coils, stents, aneurysm clips, shunts etc
Resources for clinicians:
Prostate Scotland have created a new quick-reference guide for all Scottish healthcare professionals involved in discussing PSA tests with men and trans women to ensure all patients are informed of the potential benefits and drawbacks of PSA testing. This can be downloaded here: PSA in Practice – Prostate Scotland
Advising men without symptoms of prostate disease who ask about the PSA test – GOV.UK
Scottish Cancer Referral Guidelines Review
Resources for patients:
PSA testing and prostate cancer: advice for men without symptoms of prostate disease – GOV.UK
PSA testing and prostate cancer: advice for well men aged 50 and over
