Communicate next steps with the patient to reduce chance of delayed or missed diagnosis.
Keep accurate records and detail conversations in the patient's notes.
Making timely referrals where patients need further investigations.

Prostate cancer is the most common cancer in men in the UK, particularly those aged 75 to 79 years. According to the charity Movember, one in eight UK men will be diagnosed with prostate cancer in their lifetime. It's often diagnosed after finding an elevated prostate-specific antigen (PSA) level in the primary care setting.

The number of men being diagnosed with prostate cancer has increased over the last 10 years. This may be due to more men having PSA tests and because the population is getting older.

Testicular cancer is less common, accounting for about 1% of cancers that occur in men. However, testicular cancer is the most commonly diagnosed cancer in young men in the UK. Symptoms can include a painless swelling or lump in the testis or a change in the texture or shape of the testicles. There are different types of testicular cancer with the most common type being a seminoma, which accounts for approximately 40 to 50% of testicular cancers.

MDU cases

In a previous study, the MDU received 106 cases over a two-year period relating to male cancers. Ninety-two per cent involved the MDU supporting GPs, with the other 8% being consultants. The majority of these were urologists, but other consultant specialities included general medicine, radiology and oncology.

The overwhelming majority of these cases alleged a delayed diagnosis of prostate cancer (81%), with the other 19% alleging delayed diagnosis of testicular cancer.

The most common reasons for complaints are:

delayed referral – patients diagnosed with testicular cancer commonly alleged there had been a delayed referral after they found a lump or other abnormality of the testis.
continuity of care problems – for some patients who had seen several different doctors, poor continuity of care was felt to be a contributory factor to the diagnosis delay.
follow-up arrangements – in one-third of the cases related to a delayed diagnosis of prostate cancer, there had been an alleged failure to appropriately follow up with a repeat test or examination.

Avoiding diagnosis delays

It’s often difficult to diagnose prostate cancer and testicular cancer as the symptoms can be difficult to distinguish from less serious illnesses. So what can doctors do to minimise the risk of a delayed diagnosis?

Communicate next steps with the patient

Good communication between a doctor and patient is of the upmost importance and can reduce the chance of a delayed or missed diagnosis, so discuss and agree next steps with the patient.

This discussion should focus on any investigations you intend to pursue, your proposed treatment and what response the patient might expect, possible side effects of any medications, the timescales of the treatment and plans for follow-up.

It’s often helpful to give this information to the patient in writing so they have a record of what you discussed and can refer to it in the future. This information should also be noted in the patient's records.

Keep accurate records

Remember to detail all conversations in the patient’s notes along with the details of any physical examination, including both positive and negative findings and any investigations you intend to carry out.

It’s particularly important to keep accurate records when multiple doctors are involved in the patient’s care, to ensure that symptoms and test results are not missed and referral is not delayed.

Make timely referrals

Where patients need further investigations, refer them quickly and efficiently for tests or to a specialist, and make sure you have systems in place that prompt you to write referral letters as soon as possible after a consultation.

It may also be useful to have a system in place for tracking test results, so you can follow up if they don't arrive in the expected timescales.

If things go wrong

If something does go wrong, you should explain what has happened and offer an apology to the patient. It’s also important to try to put matters right by taking appropriate steps to deal with the consequences and arrange appropriate treatment and follow-up.

Adverse incidents should be reviewed under your clinical governance procedures, so you can analyse and learn from any mistakes made.

Delayed diagnosis in prostate and testicular cancer

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