Being referred to a urologist can cause some anxiety, especially if you are not sure what will happen. Most first appointments follow a clear pattern. Knowing what to expect means you can relax, give the right information and leave with a plan.
Why you may be referred
Men are referred to a urologist for many reasons, including:
- a raised PSA result
- changes in passing urine, such as a weak flow or getting up at night
- blood in the urine or semen
- an abnormal prostate examination by a GP
- a family history of prostate cancer
Many of these turn out to have a non-cancerous cause, such as benign prostatic enlargement, an infection or inflammation of the prostate. A referral does not mean that a serious problem has been found; it means a specialist is the right person to look into your symptoms or results properly.
The conversation
The appointment usually starts with a detailed discussion. You may be asked about:
- Your symptoms: what they are, when they started and how they affect daily life.
- Urinary habits: how often you go, whether you get up at night and how strong the flow is.
- Sexual function: any changes in erections or ejaculation.
- Medical history: past illnesses, operations and current medicines.
- Family history: particularly prostate, breast or ovarian cancer.
- Lifestyle: smoking, alcohol, exercise and work.
You may be asked to fill in a short questionnaire about urinary symptoms, such as the International Prostate Symptom Score.
The examination
The urologist may examine your abdomen and genitals. A digital rectal examination is also common. This involves the doctor gently placing a gloved, lubricated finger into the back passage to feel the size, shape and texture of the prostate. It takes less than a minute and, although it can feel uncomfortable, it should not be painful.
Tests you may have
Depending on the reason for your referral, tests may include:
- a urine test to check for infection or blood
- a PSA blood test, if one has not been done recently
- a urine flow test, where you pass urine into a special toilet
- a bladder scan to see how much urine is left after you go
- an MRI scan of the prostate, usually arranged for another day
Some tests can be done on the same day, which helps speed up a diagnosis. Others, such as an MRI, may need a separate visit, and your urologist will explain when to expect each result.
What to bring
To make the most of the appointment, bring:
- a list of your current medicines
- any previous PSA results, scans or letters
- a note of your symptoms and questions
- a family member or friend if you would like support
A bladder diary, recording how often and how much you pass urine over a few days, can be very helpful for urinary symptoms. The NHS guide to prostate problems has more background.
Questions you might ask
- What do you think is causing my symptoms?
- What tests do I need, and when will I get the results?
- What are the possible next steps?
- Who should I contact if I have questions?
Our article on essential questions to ask your prostate cancer surgeon offers more ideas if cancer is being considered.
After the appointment
You should leave with a clear plan, whether that is further tests, treatment for urinary symptoms or reassurance that no further action is needed. Prostate Cancer UK has a specialist nurse helpline if questions come up later. Our prostate cancer page explains what happens if cancer is diagnosed.
Professor Prokar Dasgupta sees patients for first appointments at The London Clinic, 145 Harley Street. You can read more about Professor Dasgupta, or contact the clinic to book a consultation.