Delayed diagnosis in prostate and testicular cancer

Advice on minimising the risk of a delayed diagnosis in prostate and testicular cancer.

Prostate cancer is the most common cancer in men in the UK, particularly those aged 75 to 79 years. According to the charity Movember, 1 in 8 UK men will be diagnosed with prostate cancer in their lifetime. It is generally 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 and this may be due to more men having PSA tests and also 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 45% of testicular cancers.

Michelle Terry, CEO of leading men’s health charity Movember, said:

"Early detection of male cancers are the key to successful treatment but with prostate cancer, in particular, often no symptoms are noticed until the disease is advanced, so it can be tricky to spot.

"Fears of COVID-19 (or worries about bothering their GP at a time when NHS services are under tremendous pressure) has meant many men have not had conversations with their doctor about their prostate cancer risk. We are worried this could mean many men have their prostate cancer diagnosed too late – when it is more difficult to treat.

"We advise any man with concerns regarding his prostate cancer risk, particularly if they are having symptoms such as difficulty urinating or blood in urine or semen, to seek medical advice. We also advise younger men to get into the habit of checking their testicles regularly so they know what’s normal for them and consult their GP if they notice any significant changes.

"Your risk of developing prostate cancer increases with age. But men who are black, and those who have a family history (a brother or father with prostate cancer), are 2.5 times more likely to get it.

"We advise men to talk to their doctor about their prostate risk at 50 and discuss whether they might need a PSA (prostate-specific antigen) blood test. If they are black or have a family history of the disease, then they need to start that conversation at 45."

MDU cases

In a previous study, the MDU received 106 cases over a two-year period which related to male cancers. 92% 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 a number of 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 a failure to appropriately follow up with a repeat test or examination. 

Avoiding diagnosis delays

It is 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 is 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 is 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 was has happened and offer an apology to the patient. It is 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, in order to allow you to analyse and learn from any mistakes made.

This page was correct at publication on 16/11/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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