Urological Cancers (Prostate, Bladder, Testicular, and Penile Cancers)

🔍 When to Suspect

Prostate: lower urinary tract symptoms (LUTS), erectile dysfunction. Bladder: visible haematuria. Testicular: non-painful testicular enlargement or change in texture. Penile: penile mass or ulcerated lesion

From the full topic in The Ocean Library: Urological Cancers (Prostate, Bladder, Testicular, and Penile Cancers)

🧭 When to suspect

Urological cancers in primary care are largely an exercise in pattern recognition and correct referral:

• Recognise the cardinal presentation.

• Do the right first-line test.

• Exclude infection before acting on haematuria or prostate specific antigen (PSA).

• Refer by the correct route.

Four pictures account for most of the work:

• Prostate: lower urinary tract symptoms, erectile dysfunction, or visible haematuria, and an abnormal prostate on examination.

• Bladder and renal: visible haematuria is the cardinal sign.

• Testicular: a non-painful lump or change in the testis.

• Penile: a mass or persistent ulcerated lesion.

Treat unexplained visible haematuria as urological cancer until proven otherwise; a painless testicular lump or a hard, nodular prostate each earns a referral on its own.

Cancer	Cardinal presentation in primary care	Key referral action
Prostate	• LUTS (nocturia, frequency, hesitancy, urgency, retention), erectile dysfunction, or visible haematuria • Hard, nodular or asymmetrical prostate on digital rectal examination (DRE)	• PSA + DRE • Refer on the suspected cancer pathway if DRE feels malignant or PSA is above the age threshold
Bladder/renal	Visible haematuria – the cardinal sign	Suspected cancer pathway referral if aged ≥ 45 with unexplained visible haematuria (no UTI), or visible haematuria persisting/recurring after UTI treatment
Bladder	Non-visible haematuria with dysuria or a raised white cell count	Suspected cancer pathway referral if aged ≥ 60
Testicular	Non-painful enlargement or change in shape/texture of a testis	• Suspected cancer pathway • Consider urgent direct-access ultrasound
Penile	Penile mass or ulcerated lesion (STI excluded), or a persistent lesion after STI treatment	Suspected cancer pathway

Prostate cancer referral is driven by an age-specific PSA threshold. DRE and PSA act as independent triggers: refer if either is abnormal, and never rely on a normal DRE to exclude cancer.

Age (years)	Refer (consider suspected cancer pathway) if PSA above
Below 40	Use clinical judgement
40–49	More than 2.5
50–59	More than 3.5
60–69	More than 4.5
70–79	More than 6.5
80 and over	No age-specific threshold – individualise (see Special Notes)

Thresholds are in micrograms/litre (numerically equal to ng/mL) and apply to men with possible symptoms of prostate cancer.

Source: NICE NG12 · NICE NG131

---