NICE GUIDELINES FOR SUSPECTED CANCER: RECOGNITION AND REFERRAL JUNE 2015 UROLOGY SSG MEETING 15 October 2015 Jamal Ghaddar, Matthew Goh Department of Urology Weston General Hospital

BACKGROUND  NICE Guidelines for Suspected Cancer  2WW, 31-Day and 62-Day Targets.  2WW Referral Form.  NICE Guidelines for Suspected Cancer  New Cancer Strategy  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?