Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • renal failure from ureteric or bladder outflow obstruction
  • severe bone pain related to metastasis
  • suspected cauda equina syndrome
  • suspected spinal cord compression
  • urinary retention

Please contact the urology registrar on call to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

National Continence Helpline

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Exclusions

  • asymptomatic men with normal:
    • age-related prostate-specific antigen (PSA) and
    • digital rectal examination (DRE)
  • erectile dysfunction unrelated to surgical treatment for prostate or colorectal cancer
  • patients who have been fully investigated within the previous 12 months with negative results

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • concerning features on imaging suspicious of malignancy e.g. prostate imaging–reporting and data system
  • asymptomatic male with PSA greater than 10ng/ml above age related range
  • rectal examination findings suspicious of malignancy with or without elevated PSA

Category 2 (appointment clinically indicated within 90 days)

  • asymptomatic male with PSA less than 10ng/ml above age related range
  • risk factors for prostate cancer including family history of prostate cancer without an elevated PSA

Category 3 (appointment clinically indicated within 365 days)

  • nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • relevant past medical/surgical history
  • family history of prostate cancer
  • current medications, allergies
  • history of presenting complaint including:
    • onset
    • duration
    • concerning features
  • international prostate symptom score (IPSS)
  • physical examination findings
    • abdominal examination e.g. palpable bladder
    • digital rectal exam
    • neurological examination, exclude spinal cord compression
  • relevant diagnostic/imaging reports, including location of company and accession number
  • if prostate-specific antigen (PSA) greater than 20 consider:
    • chest-abdomen-pelvis (CAP) staging CT with contrast
    • whole body bone scan

Pathology

Additional information to assist triage categorisation

  • PSA history/trends if available

Clinical management advice

Patient compliance is required for at least two PSA tests, conducted 4-6 weeks apart, with the following guidelines:

  • no sexual activity for 5 to 7 days before testing
  • no cycling
  • no direct rectal examination (DRE) for 5 to 7 days before testing

PSA testing should not be conducted when a urinary tract infection (UTI) is present or if there has been instrumentation/insertion of an inner dwelling catheter (IDC).

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.