NICE GUIDELINES FOR SUSPECTED CANCER: RECOGNITION AND REFERRAL JUNE 2015

UROLOGY SSG MEETING15 October 2015

Jamal Ghaddar, Matthew GohDepartment of Urology

Weston General Hospital

BACKGROUND

NICE Guidelines for Suspected Cancer 2005. 2WW, 31-Day and 62-Day Targets. 2WW Referral Form.

NICE Guidelines for Suspected Cancer 2015. New Cancer Strategy 2015-2020. 4-WEEK GP Referral to Decision to Treat. 2WW Referral Form or Cancer Concern Form?

Who triages the 2WW referrals in your hospital?

A. PROSTATE CANCER

Refer for an appointment within 2 weeks:

Prostate feels malignant on digital rectal examination. [new 2015]

PSA levels are above the age-specific reference range. [new 2015]

A. PROSTATE CANCER (DISCUSSION)

Specify features of a malignant-feeling prostate?

PSA/DRE specified in the referral?

Define the PSA age-specific ranges?

UTI to be excluded, with repeat PSA following treatment?

Clarify pathway for patients with reduced life expectancy?

Clarify pathway for men over 80 years?

B. BLADDER CANCER

Refer for an appointment within 2 weeks:

Age ≥45: visible haematuria (unexplained) without urinary tract infection.  [new 2015]

Age ≥45: visible haematuria that persists or recurs after successful treatment of urinary tract infection.  [new 2015]

Age ≥60: non-visible haematuria (unexplained) and either dysuria or a raised white cell count on a blood test.  [new 2015]

B. BLADDER CANCER (DISCUSSION)

‘Unexplained’ haematuria?

Definition and diagnosis of UTI?

Definition of successful treatment of UTI?

Definition of dysuria?

Specify what constitutes a raised WCC?

C. RENAL CANCER

Refer for an appointment within 2 weeks:

Age ≥45: visible haematuria (unexplained) without urinary tract infection.  [new 2015]

Age ≥45: visible haematuria that persists or recurs after successful treatment of urinary tract infection.  [new 2015]

C. RENAL CANCER (DISCUSSION) Incidental renal lesions on imaging?

D. TESTICULAR CANCER

Refer for an appointment within 2 weeks:

Non-painful enlargement or change in shape or texture of the testis. [new 2015]

Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms. [new 2015]

D. TESTICULAR CANCER (DISCUSSION)

Specify body of testis?

Clarify change in texture?

State findings on transillumination?

The use of Valsalva?

The use of direct-access ultrasound?

E. PENILE CANCER

Refer for an appointment within 2 weeks:

A penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause.  [new 2015]

A persistent penile lesion after treatment for a sexually transmitted infection has been completed. [new 2015]

Unexplained or persistent symptoms affecting the foreskin or glans. [new 2015]

E. PENILE CANCER (DISCUSSION) Clarify time period after STI treatment when the

lesion is considered ‘persistent’?

GU medicine involvement?

Clarify unexplained or persistent symptoms affecting the foreskin and glans?

State the features of benign Peyronie’s disease?