Document ID: chunk:federal_register_of_legislation:F2025C00214:clause:1_18:p1
Version: federal_register_of_legislation:F2025C00214
Segment Type: clause
Provision Reference: sch 1 cl 18 (pt 1/2)
Character Range: 333916–336454

18                            63507 to 63522 and 63551 to 63560  12 months           3

2.5.9A  Circumstances for suspecting prostate cancer for item 63541
 (1) For the purposes of subparagraph (a)(ii) of item 63541, the circumstances for suspecting a patient of developing prostate cancer are that:
 (a) 2 PSA quantitation tests have been performed for the patient, with an interval between the tests of at least 1 month but not more than 3 months; and
 (b) subclause (2), (3), (4), (5) or (6) applies to the patient.

Patients at least 70 years of age
 (2) This subclause applies to a patient if:
 (a) the patient is at least 70 years of age; and
 (b) both PSA quantitation tests showed a PSA concentration of greater than 5.5 µg/L; and
 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%.

Patients under 70 years of age without increased risk due to family history
 (3) This subclause applies to a patient if:
 (a) the patient is under 70 years of age; and
 (b) both PSA quantitation tests showed a PSA concentration of greater than 3 µg/L; and
 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%.
 (4) This subclause applies to a patient if:
 (a) the patient is under 70 years of age; and
 (b) the first PSA quantitation test showed a PSA concentration of greater than 3 µg/L; and
 (c) the second PSA quantitation test showed a PSA concentration of greater than 5.5 µg/L.

Patients under 70 years of age with increased risk due to family history
 (5) This subclause applies to a patient if:
 (a) the patient is under 70 years of age; and
 (b) both PSA quantitation tests showed a PSA concentration of greater than 2 µg/L; and
 (c) a free/total PSA ratio test performed for the patient at least 1 month but not more than 3 months after the first PSA quantitation test showed a free/total PSA ratio of less than 25%; and
 (d) the patient has a first‑degree biological relative:
 (i) who has, or has had, prostate cancer; or
 (ii) who is suspected of carrying a BRCA 1 or BRCA 2 mutation.
 (6) This subclause applies to a patient if:
 (a) the patient is under 70 years of age; and
 (b) the first PSA quantitation test showed a PSA concentration of greater than 2 µg/L; and
 (c) the second PSA quantitation test showed a PSA concentration of greater than 5.5 µg/L;