Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
Dear GP
Please advise your patient that they are being referred on a 2 week pathway and they will be asked to attend
an appointment within this 2 week timeframe.
Please ensure that the patient receives a copy of the patient leaflet
Why have I been referred urgently to hospital?
We anticipate that the majority of appointments will be referred via Choose and Book.
If you are referring outside Choose and Book, please give this page to your patient so they can phone and
arrange their own clinic appointment.
Dear Patient
Your GP has asked for you to have an urgent appointment within two weeks.
Attending this appointment within two weeks is very important. Please read the leaflet: Why have I been
referred urgently to hospital?
To arrange your fast-track Urology appointment please phone 01223 256269 between 1400 to 1630 hrs on
the next working day after your visit to your GP.
You will be offered an appointment within 14 days of receipt of your GP’s referral.
Thank you
Addenbrooke’s Fast-Track Urology Clinic
__________________________________________________________________________________
For your diary/calendar:
Details of your Urology clinic appointment (as arranged by phone - see above):
Date: ............................................................................
Time:..............................................................
8 September 2010
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records
Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
Fast-track referral proforma: Suspected urology cancer
Please refer via Choose and Book or fax to: 01223 216573
Urology, Box 43
Hills Road, Cambridge CB2 0QQ
Tel: 01223 216575
I am sending an accompanying letter
__________________________________________________________________________________
Patient's details:
Surname: ............................................................
NHS No:...................................................................
Forename: ..........................................................
Hosp No: ..................................................................
Address: ..............................................................
Date of birth: ............................................................
............................................................................
Daytime Tel: ............................................................
............................................................................
Evening Tel: .............................................................
............................................................................
Mobile Tel: ...............................................................
Postcode: ............................................................
Language of choice: ................................................
Communication/understanding difficulties
........................................................................
___________________________________________________________________________________________________________________________________________________________________
Referring GP's details (please print or stamp):
Name: ........................................................................................................................................................
Surgery Address: .......................................................................................................................................
Surgery Tel: .......................................................
Surgery Fax: ............................................................
GP Signature: ....................................................
Referral Date: ..........................................................
___________________________________________________________________________________________________________________________________________________________________
NB: Department of Health urgent referral guidelines on page 3
Suspected Prostate Cancer
If UTI present treat and repeat PSA after 6
weeks. Only refer if PSA remains elevated
Incidental renal mass on imaging
(Please fax copy of imaging report)
Refer if either
Raised age related PSA
PSA (ng/ml or µg/l)
Age
40-49
50-59
60-69
> 70
Suspected Incidental Renal Cancer
Serum Creatinine ………….…..
Umol/l
Maximum PSA
2.2
3.1
4.0
5.8
Lower urinary tract symptoms
Bone pain
Abnormal rectal examination
nodule
hard
fixed
1 January 2013
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records
Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
Patient's name:...........................................................
Suspected Testicular Cancer
Date of birth: ........................................... (for continuation sheet)
Suspected Penile Cancer
Swelling in the body of the testis
Penile ulcer/lump/lesion
Haematuria – please refer to the clinical policy before referrral on
http://www.cambsphn.nhs.uk/CCPF/PHPolicies.aspx
Referral to Haematuria Clinic: only if one of the following is present:
Patient at any age with visible haematuria (VH).
Patient at any age with symptomatic non-visible haematuria (s-NVH) with persistent irritative
lower urinary tract symptoms (e.g. hesitancy, urgency, dysuria, suprapubic pain); and UTI has
been excluded.
Patient more than 50 years age with persistent asymptomatic non-visible haematuria (a-NVH),
i.e. 2 out of 3 isolated dipsticks done at weekly intervals are positive for NVH.
Patients with haematuria not fulfilling the above criteria, e.g. with renal colic or nephrological
symptoms, should be referred to the appropriate pathway.
Non-visible haematuria (NVH) is defined as  1+ on dipstick urinalysis. Trace haematuria is
considered negative. MSU is not needed to assess for haematuria but may be used to exclude
UTI.
Prior haematuria assessment at Addenbrooke's? If yes, when? …../…../…..
Warfarin
Other drugs
………..………………………...…
………..………………………...…
Aspirin
Other notable history
………..………………………...…
Allergies
If yes, please provide
………..………………………...…
details
………..………………………...…
Heart valve disease/
………..………………………...…
prosthesis
(i.e. procedure-related
endocarditis risk)
I am faxing a letter with additional background (at your discretion)
If yes, please tick if a fast-track proforma has already been faxed
(DoH Guidelines overleaf)
1 January 2013
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records
Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
DEPARTMENT of HEALTH Guidelines for Urgent Referral of Suspected Urological Cancers:

Macroscopic haematuria in adults.

Microscopic haematuria in adults over 50 years.

Swellings in the body of the testis.

Palpable renal masses.

Solid renal masses found on imaging.

An elevated age specific PSA (ng/ml or µg/L) in men with a ten year life expectancy.
Age
40-49
50-59
60-69
> 70
Maximum PSA
2.2
3.1
4.0
5.8

A high PSA (> 20ng/ml or µg/L) in men with a clinically malignant prostate or bone pain.

Any suspected penile cancer.
Addenbrooke's NHS Trust Suspected Prostate Cancer Management Pathways
Please use the jointly agreed Urology Fast-track referral proforma for all referrals.
Subsequent management within the Urology Department
PSA criteria

< 15:
2-4/52 One-stop Prostate-Biopsy Clinic

15 – 250:
2/52 Prostate Diagnostic Clinic/One-stop Prostate-Biopsy Clinic

> 250:
Urgent bone scan, 2/52 OPD, possibly without biopsy
NB: If PSA > 100:
Please prescribe an anti-androgen at point of referral
Digital Rectal Examination (DRE) criteria

nodule or hard/fixed prostate:
One-stop Prostate-Biopsy Clinic: urgency
dependent on PSA
NB: if referred on grounds of DRE:
Please send blood for a PSA at the point of
referral.
1 January 2013
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records
Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
NHS Cambridgeshire Patient Leaflet
WHY HAVE I BEEN REFERRED TO HOSPITAL?
Your General Practitioner (GP) or dentist has asked for you to
have an urgent hospital appointment within two weeks.
WHY HAVE I BEEN
REFERRED
URGENTLY
TO THE HOSPITAL?
A leaflet explaining
the urgent two week
referral system
The two week appointment system was introduced so that any
patient with symptoms that might indicate cancer, or a serious
condition, could be seen by a specialist as quickly as possible.
Attending this appointment within two weeks is very important and
will allow you to benefit from:

in most cases, early reassurance that cancer has not been
diagnosed or,

an early diagnosis and earlier access to treatment, which
is shown to improve health outcomes
DOES THIS MEAN I HAVE CANCER?
No it does not. The majority of patients referred under the two
week appointment system do not have cancer but may have
another condition requiring hospital diagnosis and treatment.
WHY HAS THE GP REFERRED ME?
GPs diagnose and treat many illnesses themselves. Occasionally
they need to arrange for you to see a specialist hospital doctor.
This could be for a number of reasons, such as:

your symptoms need further investigation

the treatment already prescribed has not been effective

investigations your GP has already arranged have shown
some abnormal results
There are national referral guidelines for your GP to use when
making a decision about whether it is appropriate to refer you for
an appointment within two weeks.
1 January 2013
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records
Urology Department, Box 43
Cambridge University Hospitals NHS Foundation Trust
WHAT SYMPTOMS MIGHT NEED AN URGENT
REFERRAL?

a lump that does not go away

a change in the size, shape or colour of a mole

CONTACT DETAILS -TWO WEEK WAIT
REFERRAL OFFICES:

Addenbrooke’s Hospital – please see your referral letter
for relevant contact telephone number
abnormal bleeding

Hinchingbrooke Hospital – 01480 363595

a change in bowel or bladder habits including increased
frequency

Peterborough Hospital – 01733 874191

persistent tiredness and/or unexplained weight loss

Queen Elizabeth Hospital – 01553 613626
WILL I NEED ANY TESTS?
You may require specialised tests. These may take place either
before or during your first hospital appointment. This will help the
specialist understand the cause of your symptoms.
It is important to attend your urgent appointment within
two weeks, because early diagnosis and early access
to treatment is shown to improve health outcomes.
WHAT DO I NEED TO DO?
Remember that being referred to a specialist does not
necessarily mean that you have cancer.

Make sure your GP has your correct address and
telephone number, including mobile number

If you do not have a confirmed appointment within one
week of seeing your GP, contact your GP practice

Let the hospital know immediately if you are unable to
attend your appointment, so the time can be offered to
someone else

It is important you arrange an alternative appointment
when cancelling

At your first hospital appointment you will be given more
information about what will happen next

You may take someone with you to your appointment if
you want to
More information about the two week appointment system and
other information is available at:

www.nhsdirect.nhs.uk

www.nice.org.uk
1 January 2013
Instruction sheet, 2-page form, 1 page notes and patient leaflet
File: in correspondence section of Medical Records