Prostate Assessment Pathway - Provider Information
Based on input from primary care providers, urologists and others, the Pathway will help improve prostate care in Saskatchewan. Primary care providers can now order diagnostic assessment of prostate for lower-risk patients, without urologist consultation. Submit referrals directly to a Prostate Assessment Centre in Regina or Saskatoon, using the referral forms below.
Patients referred to a Prostate Assessment Centre will see a prostate nurse navigator for education before a biopsy (and after, if pathology is positive for early-stage prostate cancer). With the primary care provider's permission (on a case-by-case basis), nurse navigators can convey biopsy results to patients. Nurse navigators are experienced urology nurses with specialized training and up-to-date information about prostate cancer treatment. They work in consultation with urologists.
Quick facts for primary care providers
Related documents
Achieving rapid assessment of patients who may have prostate cancer
In the following video, Prostate Assessment Pathway Chair, Dr. Kishore Visvanathan, explains the pathway, and how best to proceed with diagnosis.
Screening for prostate cancer
Related documents
Canadian Partnership Against Cancer expert panel report published in 2009: expansion of PSA testing may produce net harm.
Prostate assessment clinic tools
These tools are used by nurse navigators in the Prostate Assessment Clinics to educate patients and collect information post-treatment about patients' self-reported quality of life and clinical outcomes. Patients are surveyed using the EPIC CP tool at initial, six months and one year post treatment.
Related documents
Ordering a biopsy
For urologist-approved guidelines to help you recommend the best care pathway for your patient, continue reading Prostate Biopsy Decision Factors.
Assessment Centre
- Regina
Prostate Assessment Centre
Pasqua Hospital
4101 Dewdney Ave.
Regina, SK S4T 1A5
Phone: 306-766-6215
Fax: 306-766-2962 - Saskatoon
Leslie and Irene Dubé Urology Centre of Health
St. Paul’s Hospital
1702 – 20th Street West
Saskatoon, SK S7M 0Z9
Phone: 306-655-0520
Fax: 306-655-0519
Related documents
Prostate biopsy decision factors
There are normal, age-specific Prostate-Specific Antigen Levels (CUA 2011)
| Age | PSA level (upper limit) |
|
40-49 |
2.5 ng/ml |
| 50-59 | 3.5 ng/ml |
| 60-69 | 4.5 ng/ml |
| 70 and older | 6.5 ng/ml |
PSA screening for men over 70 years is not recommended.
PSA fluctuation
PSA levels are subject to considerable variation. Variation can be caused from irritation or trauma such as bladder or prostate infection or after instrumentation (i.e. catheter insertion), thus causing a false-positive PSA level. See PSA Fluctuation Evaluation by The Journal of the American Medical Association.
Treatment of prostate or bladder infection
Since PSA levels may increase as a result of a prostate or bladder infection, if a PSA level has been collected during a suspected or known prostate or bladder infection, a repeat PSA level should be drawn eight weeks after the completion of antibiotic treatment. If the PSA level remains elevated, further investigation for prostate cancer may be warranted.
Patient life expectancy
If a patient has a life expectancy of less than 10 years, further assessment/treatment may not be appropriate. Discuss this with your patient before screening or assessing for prostate cancer.
Urologist referral
The following situations indicate where referral to a urologist before biopsy should be considered for patients. Staff in a Prostate Assessment Centre will also refer patients directly to a urologist if concerns are detected.
Is the patient under 40 years or over 75 years, with elevated PSA?
Patients in these age groups require further assessment to determine if a prostate biopsy is necessary. If a patient is over 75 years, a prostate biopsy may not be appropriate.
Does patient have a PSA value greater than 50?
A diagnosis may be possible based on clinical findings, avoiding the need for a biopsy.
Does the patient have an abnormal digital rectal exam but PSA value is normal?
A urologist should assess the prostate to determine if the abnormality warrants a biopsy.
Has the patient had a previous biopsy?
With a previous negative prostate biopsy, subsequent biopsies may not be necessary. The likelihood of a positive finding is less likely with each subsequent biopsy.
Is the patient immunocompromised?
Additional preparation may be required prior to a biopsy.