Referral of Suspected Prostate Cancer by Family Physicians and Other Primary Care Providers

Guideline Objective

How should patients presenting to family physicians and other primary care providers (PCPs) with signs and/or symptoms of prostate cancer, including incidental prostate specific antigen (PSA) test results, be managed?

Patient Population

Adult male patients presenting in primary care settings with signs, including incidental PSA results (defined as results not ordered by the attending FP or other primary care provider [PCP]), or symptoms suggestive of prostate cancer comprise the target population.

This guideline does not provide recommendations for screening healthy patients or opportunistic PSA testing.

Intended Guideline Users

Family physicians (FPs), general practitioners (GPs), emergency room physicians, other PCPs (nurse practitioners, registered nurses, and physician assistants), and urologists. For the purposes of this document, we have referred to FPs, GPs, emergency room physicians, and other PCPs as “FPs and other PCPs”.

The guidelines are also intended for policymakers to help ensure that resources are in place so that target wait times are achieved.

Research Question(s)

1. What signs, symptoms, and other clinical features that present in primary care are predictive of prostate cancer?
2. What is the diagnostic accuracy of investigations commonly considered for patients presenting with signs and/or symptoms of prostate cancer?
3. What major, known risk factors increase the likelihood of prostate cancer in patients presenting with signs and/or symptoms of prostate cancer?
4. Which factors are associated with delayed referral? Which delay factors can be attributed to patients, and which factors can be attributed to providers or system-related factors? Does a delay in the time to consultation affect patient outcome?