Referral criteria from primary care - benign prostatic hyperplasia

Specialist referral should be considered for

• patients with severe symptoms particularly when rapidly progressive
  
  
• where rectal examination is abnormal
  
  
• in complicated BPH e.g. recurrent urinary infections, haematuria, urinary retention, obstructive nephropathy, bladder stones
  
  
• patients with raised PSA
  
  
• patients who fail to respond to drug treatment for BPH

Consider urgent referral guidance re: prostate cancer (2)

• refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination
  
  
• consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
  • any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or
  • retention or
  • erectile dysfunction or
  • visible haematuria
    
    
• refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the age-specific reference range

Reference:

• Prescribers' Journal (1999), 39 (1), 9-15.
• NICE (June 2015). Referral Guidelines for Suspected Cancer