Guideline for referral of patients with suspected prostate cancer by family physicians and other primary care providers

Abstract

Objective: The aim of this guideline is to assist FPs and other primary care providers with recognizing features that should raise their suspicion about the presence of prostate cancer in their patients.

Composition of the committee: Committee members were selected from among the regional primary care leads from the Cancer Care Ontario Provincial Primary Care and Cancer Network and from among the members of the Cancer Care Ontario Genitourinary Cancer Disease Site Group.

Methods: This guideline was developed through systematic review of the evidence base, synthesis of the evidence, and formal external review involving Canadian stakeholders to validate the relevance of recommendations.

Report: Evidence-based guidelines were developed to improve the management of patients presenting with clinical features of prostate cancer within the Canadian context.

Conclusion: These guidelines might lead to more timely and appropriate referrals and might also be of value for informing the development of prostate cancer diagnostic programs and for helping policy makers to ensure appropriate resources are in place.

Figure 1

Prostate cancer referral guideline recommendations DRE—digital rectal examination, LUTS—lower urinary tract symptoms, NZGG—New Zealand Guidelines Group, PSA—prostate-specific antigen. ^*An example of age-based PSA values (upper limit of normal) from the NZGG is as follows: 40–50 y, 2.5 μ/L; 50–60 y, 3.5 μ/L; 60–70 y, 4.5 μ/L; ≥ 70 y, 6.5 μ/L. Differences in PSA assay can lead to differences in age-based ranges reported by laboratories. ^†Nomograms are available from http://sunnybrook.ca/content/?page=OCC_prostateCalc,http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp, or www.prostatecancer-riskcalculator.com/assess-your-risk-of-prostate-cancer.