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Prostate Cancer

Emergency department referrals

Phone on call Oncology Registrar and send patient to the Department of Emergency Medicine at their nearest hospital.

Contact on call Oncology Registrar through:

  • Royal Brisbane & Women’s Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000
  • Redcliffe Hospital (07) 3883 7777
  • Caboolture Hospital (07) 5433 8888

If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Significant bleeding – including haematuria particularly with clot retention.
  • Uncontrolled or disabling pain or severe uncontrolled dyspnoea
  • Suspected spinal cord compression or cauda equina syndrome
  • Symptomatic malignant hypercalcaemia
  • Patients with a visceral crisis from suspected but not malignant diagnosis (e.g. significant liver dysfunction from malignant infiltration)
  • Acute urinary retention or ureteric obstruction secondary to malignancy
  • Febrile neutropenia calcium (>3.0mmol/L)

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Patients with new or suspected diagnosis of prostate cancer should be referred initially to the Urology service for a conclusive diagnosis and initial management and are usually discussed in a multidisciplinary team meeting and referred to a Medical oncologist for escalation of care if considered appropriate.

  • Metastatic prostate cancer. For optimum care, patient should be seen within 4 weeks.
  • Symptomatic patients with radiological evidence of locally advanced or metastatic disease and PSA > 50 ng/mL. (Note: Asymptomatic patients should be referred to a specialist urologist within 4 weeks of a persistently abnormal PSA result or a single PSA reading ≥ 10 ng/mL)

Category 2

Appointment within 90 days is desirable

  • New diagnosis of castrate resistant non-metastatic prostate cancer currently receiving androgen deprivation therapy and demonstrating evidence of a prostate-specific antigen level that was observed to have at least doubled in value in a time period of within 10 months anytime prior to first commencing treatment with this drug.
  • New diagnosis of hormone sensitive metastatic prostate cancer for consideration of escalation of therapy from androgen deprivation therapy alone (within 6 months of commencement of androgen deprivation therapy) to include a novel anti-androgens +/- chemotherapy (Note: patients should have a histological diagnosis of prostate cancer)
  • Transfer of care from another health service

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

  • Refer to local HealthPathways or local guidelines
  • Patients with suspected but not confirmed prostate cancer should be referred to Urologists Specialist review optimally should be within 4 weeks
  • If there are signs or symptoms suggestive of metastases consider:
    • CT and bone scan, often after confirmation of a prostate cancer diagnosis, the patient’s Specialist may arrange a PSMA-PET scan and /or and MRI of the prostate depending on the stage of the disease and the patient, if appropriate.
    • Most referrals for early, locally advanced and metastatic prostate cancer for antiandrogen therapy, chemotherapy and novel antiandrogen therapies come through the Urology team and after MDT review
  • For patients with incurable (metastatic or recurrent) cancer, consideration of the following:
    • documentation of discussions with the patient (and their carers where appropriate) regarding the intent of treatment (anti-cancer therapy to improve quality of life and/or longevity without expectation of cure or symptom palliation), the patient’s prognosis and their understanding of their prognosis
    • whether Advance Care Planning (ACP) conversations have been undertaken and their outcome
    • specific patient goals and values that may impact on treatment choices
    • whether the patient has been referred to a palliative or supportive care service

 

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Past medical history, current medications
  • Previous cancer treatment details
  • Histopathology
  • FBC, U&E, LFT, prostate-specific antigen level, Lactate dehydrogenase (LDH) results
  • Serial PSA results
  • Either a PSMA PET scan results or CT chest abdomen and pelvis and bone scan

Additional referral information (useful for processing the referral)

  • Any relevant XR results and/or relevant CT results

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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