Reasons for complaints included:

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. One patient was diagnosed with an advanced seminoma secondary to an undescended testis. Three patients had metastatic disease by the time they received their diagnosis.

Continuity of care problems

Patients alleging a delayed diagnosis of prostate cancer commonly had a variety of symptoms and medical problems, including urinary symptoms, haematuria, back and hip pain, erectile dysfunction and prostatic hyperplasia. In 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 act on a high PSA result or the patient had not been appropriately followed up with a repeat test or examination. One patient had prostatic hyperplasia and a raised PSA level. Another requested a PSA test due to a positive family history but had been refused, and was ultimately diagnosed with prostate cancer.

Avoiding diagnosis delays

Diagnosis of male cancers is by no means straightforward as symptoms and signs can be difficult to distinguish from less serious illnesses. However, there are steps that doctors can take to minimise the risk of a delayed diagnosis and the harm that can be caused to the patient. These include:

Be aware of recommended guidance

NICE recommends that a PSA test and digital rectal examination is performed for men who present with any lower urinary tract symptoms, including nocturia, urinary frequency, hesitancy, urgency or urinary retention. They should also have a PSA and rectal examination if they present with erectile dysfunction or visible haematuria.

Men should also be referred under a suspected cancer pathway referral if their prostate feels malignant on digital rectal examination or if their PSA level is above the age-specific reference range.

You should make a consideration for a referral under the suspected cancer pathway for patients presenting with a non-painful enlargement or change in the shape or texture of the testis. Also, consider a direct access ultrasound scan for men with unexplained or persistent testicular symptoms.

Common factors in delayed diagnosis of male cancers

Common factors in delayed diagnosis of male cancers