Organisation we investigated: Lancashire Teaching Hospitals NHS Foundation Trust
Date investigation closed: 11 April 2019
Complainant A complained on behalf of Person P about the failure of the Trust to diagnose Person P’s prostate cancer. Complainant A said that Person P had complained of symptoms typical of prostate cancer and had even asked for a prostate biopsy, but the Trust ignored them and gave repeated courses of antibiotics that did not work.
What we found
It was reasonable for the Trust to diagnose Person P with prostatitis when it first saw them, as they did not have significantly elevated PSA and their symptoms were in line with the guidance on diagnosing prostatitis.
However, it was not reasonable to continue with this diagnosis when Person P’s PSA was high and other tests to diagnose prostatitis were negative.
NHS target cancer waiting times say that patients should not wait longer than 62 days (two months) from referral to first definitive treatment. To meet that target, all investigations should have been arranged as promptly as possible. We found that this did happen within the target and that there was no evidence of any urgency in making a diagnosis. We found that in total, Person P waited eight months, rather than two, for their first definitive treatment — a delay of six months. The Trust did not carry out appropriate investigations to exclude the possibility of prostate cancer at the right time.
There was a delay of six months in diagnosing them with cancer.
Given the significant link between early diagnosis and treatment and improved outcomes (in terms of survival rates or reducing symptoms), we found that Person P had a reduced quality of life and that the length of their life is likely to have been affected. There was also a lost opportunity to give Person P the best chance of a cure. Person P said that they are upset at the treatment they received and the likely effect this had on their illness. Complainant A told us that they have also been caused significant upset.
Person P saw a urology consultant (the Consultant) several times. The Trust first gave Person P medication to treat an enlarged prostate and then antibiotics to treat prostatitis (infection of the prostate). The Trust carried out diagnostic tests, including a cystoscopy (a procedure to look inside the bladder) and a kidney scan. The results of these tests were normal. Person P saw the consultant again when the antibiotics did not work but the Trust discharged them.
Person P’s GP arranged for a PSA test (a blood test that measures the amount of prostate specific antigen (PSA) in the blood and that can be an indicator for prostate cancer), which was normal.
A year later Person P’s GP referred them back to the Trust under the twoweek referral for cancer as they had raised PSA levels. The Trust gave Person P antibiotics for prostatitis.
The Consultant saw Person P the following month and found their PSA had risen again. The Trust diagnosed prostatitis, although a semen culture was negative, and the previous course of antibiotics had failed to work. Ten weeks later, when Person P saw the Consultant again, and their PSA had risen even further.
The Consultant wrote to the GP to inform them that the Trust would arrange an MRI and bone scan within two weeks. The Consultant also said they would see Person P again within four weeks. The Trust carried out a prostate biopsy seven weeks later which confirmed that Person P had advanced prostate cancer.
Putting it right
We recommended that the Trust should ensure that the Consultant works with their clinical supervisor to ensure that their practice is in line with current guidance and research in relation to diagnosing prostate cancer. The Trust should also write to Person P and Complainant F to inform them that this has taken place.
We also recommended that the Trust should pay Person P £5,000 in recognition of the injustice suffered and write a letter of apology to them and Complainant A
The Trust complied with our recommendations
This case summary is featured in the Ombudsman's Casework Report 2019.