Urological 2ww Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.


REFERRAL GUIDELINES FOR SUSPECTED UROLOGICAL CANCER (All patients will be seen within 2 weeks of referral)

  • Refer a patient who presents with symptoms suggestive of urological cancer as detailed in the NICE guidance below.
  • Only refer when patient is available to attend an appointment within the next 14 days.



Referral Criteria


  • Urgent 2ww if:
    • Prostate is hard, irregular which is typical of a prostate carcinoma
    • PSA should be measured and the result should accompany the referral
    • A normal prostate, but rising/raised age-specific PSA, with or without lower urinary tract symptoms
    • In men with LUTS, erectile dysfunction or visible haematuria please consider a PSA test
    • With PSA levels above age specified reference range
  • Non-urgent referral if:
    • Significant other comorbidities, a discussion with the patient, carers and/or specialist may be more appropriate
    • The prostate is simply enlarged and the PSA is in the age-specific reference range


  • Urgent 2ww if:
    • Aged ≥45 years who present with unexplained visible haematuria without a UTI or visible haematuria that persists or recurs after successful treatment of a UTI
    • Aged ≥45 who have unexplained non visible haematuria with recurrent or persistent unexplained UTI
    • Aged ≥ 60 years who have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
  • Non-urgent referral if:
    • Refer non-urgently patients under 50 years of age with microscopic haematuria
    • Patient with proteinuria or raised serum creatinine should be referred to a renal physician. If there is no proteinuria and serum creatinine is normal, a non-urgent referral to a urologist should be made
    • Aged > 60 with recurrent or persistent unexplained urinary tract infection


  • Urgent 2ww if:
    • A non‑painful enlargement or change in shape or texture of the testis
    • Consider an ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms


  • Urgent 2ww if:
    • A penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause, or
    • A persistent penile lesion after treatment for a sexually transmitted infection has been completed
    • With unexplained or persistent symptoms affecting the foreskin or glans.
  • Non-Urgent referral if:
    • Lumps within the corpora cavernosa can indicate Peyronie's disease, which does not require urgent referral

Referral Instructions

Supporting information

Assurance & Governance

  • This guidance was developed on: 05.2017
  • This guidance was ratified by: OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 02.2020
  • Ref No: CA12 – 05.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
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