University Hospitals of Morecambe Bay NHS Foundation Trust

3. Mrs L complains the Trust failed to diagnose her husband, Mr L’s prostate cancer sooner. Mrs L says it did not request simple tests that would have identified Mr L’s prostate cancer in 2019, 2020 and 2021.

4. Mrs L says Mr L’s death was both premature and avoidable had the Trust taken appropriate action and diagnosed him sooner.

5. Mrs L has told us she is still experiencing profound grief and distress from the loss of her husband. She has told us the Trust’s actions have had a lasting impact on her own health and wellbeing.

6. To resolve her complaint, Mrs L would like the Trust to acknowledge its failings. Mrs L is also seeking service improvements.

7. This background is only intended to place the key events related to this complaint in context, not to provide a detailed chronological account of everything that happened.

8. Mr L attended the Trust in September 2018 with a suspected infection of his prostate.

9. In October 2018, Mr L was seen by the urology team at the Trust. It obtained a Prostate-Specific Antigen (PSA) test. This test measures the level of PSA (protein produced by the prostate gland) in your blood and is used to help diagnose prostate cancer. The Trust reported the PSA test as normal.

10. Mr L remained under the care of the Trust and was being treated for an enlarged prostate which it thought to be benign. Mr L had urinary symptoms such as poor flow, incomplete emptying and an underactive bladder.

11. In November 2021, the Trust diagnosed Mr L with metastatic prostate cancer (when prostate cancer spreads from the prostate gland to other parts of the body).

12. Mrs L acknowledges the results in 2018 were not concerning but is left wondering why the Trust did not repeat the PSA test after Mr L’s enlarged prostate and associated symptoms did not improve in 2019, 2020 and 2021 and he remained under the care of the urology department.

13. Sadly, Mr L died in March 2023 after his health did not improve.

17. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

18. Mrs L told us she is concerned the Trust did not do enough to diagnose her husband’s prostate cancer sooner. Mrs L believes the Trust should have regularly monitored her husband’s PSA levels after concerns were first raised about this in October 2018. Mrs L says the Trust should have obtained periodic investigations, including testing Mr L’s PSA levels and carried out digital rectal exams (DRE) (A DRE is a medical test used to check for problems in the rectum, anus, and prostate gland). Mrs L says this would have allowed the Trust to diagnose Mr L sooner than it did in November 2021.

19. The Trust responded to Mrs L’s complaint and said because Mr L’s PSA/prostate results were negative for cancer in October 2018 there was no need to repeat tests for him. The Trust said Mr L’s prostate cancer suddenly developed and was an aggressive and abnormally behaving type of cancer.

20. Prostate Cancer UK explains it is normal to have a small amount of PSA in the blood, and the amount rises slightly as you get older, and your prostate gets bigger. A raised PSA level may suggest there is a problem with your prostate, but not necessarily cancer. If the PSA level is less than 3ng/ml this suggests a normal result. However, this will vary from person to person and depends on other factors including age, general health, medication and other known urinary symptoms.

21. In October 2018, Mr L attended the Trust’s urology team at its one stop clinic. His records show a clinician examined his prostate at the time and obtained a PSA test. Mr L’s PSA results were recorded as 1.5 ng/ml. The Trust reported this was within the normal range. It also carried out a DRE for Mr L and noted that his prostate was small and not suspicious. The Trust investigated his urinary symptoms and prescribed medication for Mr L.

22. NICE NG131 guidance explains repeat testing, including obtaining a PSA and carrying out a DRE is required under specific circumstances. The guidance says if a person has a raised PSA level and an MRI Likert score (a way to describe how likely it is that a man has significant prostate cancer based on MRI scans) of 1 or 2 and has not had a prostate biopsy, a repeat PSA test should be done at 3 to 6 months. It also says PSA repeat testing is indicated for people who have undergone treatment for prostate cancer or who have been diagnosed with prostate cancer and are being closely monitored without treatment. We can see from the evidence we have obtained Mr L does not fall into these circumstances.

23. Our adviser told us there is no guidance which recommends repeating PSA testing or carrying out further DRE when PSA levels have been tested and found to be in a normal range. They told us the Trust acted appropriately when it initially investigated Mr L’s urinary symptoms and considering a possible prostatitis diagnosis (inflammation of the prostate gland).

24. Considering the guidance we have outlined in paragraph 24 and the views of our adviser; we cannot see any indication of failings in relation to the action the Trust took regarding any further investigations for Mr L’s prostate.

25. We are very sorry to hear of how distressing this time was for Mr L and for Mrs L to see her husband become so unwell. From our consideration of the complaint, we have not seen the Trust acted inappropriately in not requesting further tests to help it diagnose Mr L’s prostate cancer sooner. We hope our decision provides Mrs L with assurance about what happened with her husband’s care.

1. Mrs L complains about aspects of the care and treatment the Trust provided to her husband, Mr L. We have carefully considered the evidence, and we do not see any indications of failings in the complaint raised about the Trust.

2. As we have seen no indication of wrongdoing, we have decided not to investigate further. We recognise how important this complaint is to Mrs L, and we extend our condolences to her on the loss of her beloved husband.