Evaluating the management pathway for suspected testicular cancer: Results from the BAUS EMPAST national audit

Objective: To characterise contemporary United Kingdom (UK) practice for suspected testicular cancer referrals and benchmark performance against the NHS Faster Diagnosis Standard (FDS). Materials and Methods: EMPAST (Evaluating the Management Pathway for Suspected Testicular Cancer) is a British Association of Urological Surgeons (BAUS)-affiliated national retrospective audit. It comprised a unit-level questionnaire and two anonymised cohorts: patients referred with suspected testicular cancer (June–July 2025) and confirmed cancer undergoing orchidectomy (April 2023–March 2024). Timeliness to consultation and outcome communication was assessed against 14-day and 28-day (FDS proxy) standards. Analyses used descriptive statistics and logistic regression. Results: Across 107 centres, 1818 submissions were analysed (773 diagnostic; 947 confirmed cancer). Median referral-to-consultation time was 7.5 days (IQR 5–14), with 79% seen within 14 days. Median referral-to-outcome communication was 14 days (IQR 8–25), and 81% achieved the FDS proxy. Pre-referral ultrasound (PRUS) occurred in 18.6% of cases and was associated with a higher proportion of cancer diagnoses in the referred cohort (60% vs 9.7%) and higher FDS proxy achievement (OR 1.10, 95% CI 1.06–1.84, p < 0.01). Median referral-to-orchidectomy time was 23 days (IQR 15–35). Conclusions: UK suspected testicular cancer pathways demonstrate good diagnostic timeliness but variation in pathway configuration between units highlights opportunities for optimisation. Level of evidence: 4