Reviewed on : 13 Oct 2026

Reviewed by : Jack Bambrough – GP Gateway Editor

Expires : 13 Oct 2028

Urology Urgent Suspected Cancer Referrals

Indications for an urgent referral for a suspected new malignancy in line with NICE Guidelines are:

Bladder

• Unexplained visible haematuria without UTI ≥45 years age
• Visible haematuria persisting/recurring after UTI treatment ≥45 years age
• Non-visible haematuria + dysuria OR ↑WCC on a recent blood test ≥ 60 years age

Testicular

• Non-painful enlargement or change in shape or texture of the testis (swelling in body not epididymis)

Renal

• Palpable Renal Mass

Penile

• Penile Mass/Ulcerated Lesion STI excluded
• Persistent Penile Lesion following completed STI treatment
• Unexplained or persistent symptoms affecting the foreskin or glans

Radiological

• Abnormal imaging: suspicious of urological cancer

Prostate

• Agre related raised PSA
• DRE findings abnormal (DRE mandatory only if PSA is normal)

If the initial PSA test is between 7.5 – 20 ng/L and there are no symptoms suggestive of metastatic disease, repeat PSA ONCE after 6 months in primary care, prior to any secondary care referral.

When the PSA is repeated, offer referral via the suspected cancer pathway if:

— the PSA is >20ng/mL or over 7.5ng/mL with symptoms suggestive of metastatic disease (bone pain and/or fatigue and/or significant unintended weight loss). OR— PSA has increased significantly (more than doubled).

If patients do not fit the above criteria but clinical concern remains, seek appropriate support via ‘advice and guidance’.

Pre Referral Investigations required for ALL PATIENTS

EGFR Result (within last 3 months)

PSA level (Prostate referrals only)

Negative MSU/Dipstick Test (within last 8 weeks)

PSA should not be taken during, or within 8 weeks, of a proven UTI as this may cause an artificially raised level

Consider handing the patient a Cancer Research UK Information Sheet – follow link

Urgent suspected cancer referrals should be processed through the NHS eReferral Service.