Saving Lives, One Recommendation at a Time: The DJiP Project's Impact on Prostate Cancer Diagnosis

In this blog, we will discuss our funded research study called DJiP – Diagnostic Journeys in Prostate Cancer – which investigated the experiences of prostate cancer patients.

There are between 2500–3000 men diagnosed with prostate cancer every year in Wales, making it the most common cancer of all. Sadly, around 1 in 5 of these cases is diagnosed at Stage IV, when the cancer has spread and so is very difficult to treat. 

Unfortunately, late diagnosis of cancer is a particular problem in Wales, which is why Cancer Research Wales funded the DJiP (Diagnostic Journeys in Prostate cancer) project, based at the North Wales Centre for Primary Care Research in Wrexham and led by Professor Clare Wilkinson.

In the DJiP study, the team sought to understand why so many cases of prostate cancer are diagnosed at a late stage and whether there are areas of the patient journey that could be improved to alleviate this issue. 

In order to gather the evidence they needed, the team surveyed 250 prostate cancer patients from across Wales, as well as GPs and urologists, to explore their experiences with prostate cancer and whether they had come across any significant challenges or barriers.

The study found that over half of the patients they surveyed had been experiencing symptoms of prostate cancer for up to 2 years before they saw their GP. Around a quarter of the patients reported experience of more than 4 different potential symptoms in that time. 

In addition, it was found that many of the men who took part in the DJiP study felt confused by the conflicting information and guidance that was available to them, with a lack of clear advice discouraging them from requesting appointments with their GPs. In today’s climate where many people are finding it difficult to obtain a GP appointment, this is only likely to worsen.

These frequently long delays in seeking help and advice from the GP, even in the face of numerous symptoms, were a key driver of late cancer diagnosis.

Concerningly, 60% of the patients that were interviewed by the DJiP team felt that they hadn’t experienced any symptoms prior to their diagnosis, when in fact they had but simply hadn’t realised or hadn’t associated them with prostate cancer. 

This lack of awareness of prostate cancer symptoms was also an important factor in late diagnoses, with many men visiting their GP for other health issues and only then discussing their symptoms and prompting the GP to order appropriate tests.

Confounding the issues caused by delays in patients seeking help, the DJiP study also found that there was variation among GPs in their application of the official NICE referral guidelines for prostate cancer, with some preferring to lean on their own knowledge and experience instead of following the guidelines. 

This echoes the findings of the Cancer Research Wales funded WICKED study, which found similar variations among GPs across Wales for a range of different cancer types. 

Based on their findings, the DJiP team proposed several simple recommendations to enhance the diagnostic journey of men with prostate cancer.

Chief among these was improvements to public health messaging, ensuring that the symptoms of prostate cancer and advice on what to do if concerns arise are presented clearly and consistently. Often it was found that men associated their symptoms with simply getting older, so clear advice on when to seek a consultation with a GP is vitally important.

The team also recommended improvements to safety netting procedures, which are put in place to follow up patients and their test results to ensure that no one falls through the cracks and is lost in the system. 

This again closely aligns with the ThinkCancer! clinical trial that Cancer Research Wales is funding, one element of which is dedicated to setting up and optimising safety netting processes in GP surgeries.

Prostate cancer, as the most commonly diagnosed cancer in Wales and responsible for over 600 deaths each year, represents a major burden on health services. 

It is therefore of utmost importance that men are made aware of the symptoms and understand when to seek their GP’s advice, so that more cases can be detected an earlier stage and more lives can be saved.

The DJiP project represents one of several projects in our Health Systems and Outcomes research theme. Learn more about our research here.