Prostate Cancer

• 99% of cases occur in men aged > 50 years
• About 25% of cases present in men aged < 70 years when life expectancy is > 10 years
•  Presenting features include raised prostate specific antigen (PSA), an abnormal rectal examination and bone pain
• Lower urinary tract symptoms are common in the normal population of this age and are not a reason for suspecting prostate cancer
• Early, potentially curable, prostatic cancers are either impalpable or have only a small nodule and a PSA that is generally less than 15 ng/ml
• The age specific upper limit of normal for PSA rises from 2.8 aged 50 up to 5.3 aged 70
• Patients with a first degree relative with prostate or breast cancer are at higher risk of developing prostate cancer and Afro-Carribeans probably have an increased risk

• PSA testing of asymptomatic men or screening for prostate cancer is no national policy. It is recommended that a PSA test, except in men clinically suspicious of prostate cancer should only be performed after full counselling and provision of written information

Bladder/Urothelial Cancers

• 95% affect the bladder; 5% affect the upper tracts
• 90% present with macroscopic blood in urine
• 5-10% present with microscopic blood in urine
• Both macroscopic and microscopic blood in urine, when caused by a urological cancer are intermittent. Repeat urine testing can be negative for blood in urine in the presence of a tumour

• Urological cancer is more likely in patients with microscopic blood in urine if they are males, over 50 years and smokers

• Microscopic blood in urine in patients under 40 years should be considered for referral especially if there is protein in the urine, high blood pressure or renal impairment

Kidney Cancer

• Macroscopic blood in urine is the commonest presenting symptom
• Other presenting features include loin pain, renal masses, microscopic blood in urine, anaemia, weight loss and pyrexia
• Renal cancers are increasingly found incidentally on abdominal imaging (e.g. CT or ultrasound)

Testis Cancer

• Scrotal swellings are relatively common in general practice
• Solid swellings affecting the body of the testis have a high probability (.50%) of being due to cancer
• Indeterminate swellings of the testicle have a low probability of being due to cancer especially in men over 55 years and should be considered for ultrasound before referral
• Swellings outside the body of the testis are hardly ever due to cancer and need not be referred urgently

See your doctor if you have:

• Obvious blood stained urine in adults
• Microscopic blood in urine on testing in adults over 50 years
• Swellings in the body of the testis
• Palpable renal mass
• An elevated age specific PSA in men with a ten year life expectancy
• A high PSA (> 20 ng/ml) in men with a clinically malignant prostate or bone pain
• Any swelling/ulceration of penis