Difficulties with early prostate cancer diagnosis: a multi-perspective mixed-methods study

Background Despite progress in treatment, the early stages of diagnosing prostate cancer remain difficult to navigate. GPs often work with vague symptoms and imperfect tests without a routine screening programme. Understanding how patients, GPs, and secondary care urologists experience the diagnostic process is important to inform efforts to improve pathways and reduce delays. Aim The aim was to map the timing and sequence of key events in men's initial diagnostic journeys, explore decision-making of patients, GPs, and urologists, and identify points where earlier or more equitable diagnosis might be supported. Design & Setting A mixed-methods study conducted in Wales, UK, combining descriptive questionnaire data with thematic qualitative interviews and focus groups. Method Questionnaire data from 210 patients, 65 GPs, and 69 urologists were analysed descriptively. Qualitative interviews and focus groups with patients (n = 24), GPs (n = 18), and secondary care clinicians (n = 11) were analysed thematically. Results Patients described symptom recognition delays, and multiple barriers to diagnosis including accessing appointments, repeat presentations, and diagnostic test waits. GPs highlighted challenges in managing uncertainty and variation in access to investigations. Urologists described limitations in resources and referral pathways. All described delays were shaped by wider systemic factors as well as primary care processes. Conclusion Delays in prostate cancer diagnosis stem not only from primary care, but also from system-wide challenges. Consistent pathways and improved access to diagnostic tests may reduce variation and delays. Understanding men's experiences and journeys to diagnosis will inform service improvement.