Diagnosis of prostate cancer in primary care: navigating updated clinical guidance

Abstract

PROSTATE CANCER IN THE UKProstate cancer became the most common cancer diagnosed in males in the UK in 2018, with around 52 300 new cases. 1The COVID-19 pandemic impacted prostate cancer diagnoses more than any other tumour type and up to 14 000 fewer prostate cancer cases were detected in the first 2 years of the pandemic than would be expected based on long-term trends. 2,3This was thought to be in part due to fewer patients coming forward to their GP with symptoms warranting an urgent suspected cancer ('2-week wait') referral or to discuss opportunistic prostatespecific antigen (PSA) screening.Early-stage diagnosis (stage I/II) of clinically significant prostate cancer is crucial for improving outcomes for patients with prostate cancer.Five-year survival for patients with prostate cancer diagnosed at stage I or II is close to 100%, whereas for patients diagnosed at stage IV, around 50 out of every 100 menaround 50% -will survive their cancer for 5 years or more after they are diagnosed. 4he delays in prostate cancer diagnosis for thousands of patients as a result of the pandemic could have significant long-term effects.This will make achieving the NHS Long Term Plan aim of diagnosing 75% of patients with early-stage cancer by 2028 all the more difficult. 5he vast majority of patients with prostate cancer are diagnosed following a referral from their GP.Over half of these patients are referred via the 2-week wait pathway, and another quarter following a routine GP referral to urology. 6Prostate cancer diagnoses following emergency presentation are an uncommon occurrence. 6rostate cancer is usually suspected in primary care with either an abnormal digital rectal examination (DRE) of the prostate or an elevated PSA level.The presence of one of these clinical features is an indication for a 2-week wait referral according to National Institute for Health and Care Excellence (NICE) guidance 12 (NG12). 7

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