Targeted Prostate Health Checks, a Novel Screening System to Identify Men at Risk of Prostate Cancer: Real-world Evidence from More than 18 000 Prostate-specific Antigen Tests.

BACKGROUND AND

OBJECTIVE

The Targeted Prostate Health Check (TPHC) programme was set up to identify men with prostate cancer (PC) in the Surrey and Sussex region of England that was undetected during the COVID-19 era. We report outcomes for more than 18 000 prostate-specific antigen (PSA) checks using modern diagnostic techniques.

METHODS

Men aged 50-70 yr, or 45-70 yr if Black or with a family history of PC, were identified via primary care (general practitioner [GP]) records. Text messages invited men to visit www.talkprostate.co.uk for information on PC and consent to PSA checks coordinated by Medefer, a virtual health care provider. Elevated age-related PSA (40-49 yr: >2.5 ng/ml; 50-59 yr: >3.5 ng/ml, 60-70 yr: >4.5 ng/ml) or a level ≥3 ng/ml triggered referral for multiparametric magnetic resonance imaging (mpMRI) and, if indicated, local anaesthetic transperineal (LATP) biopsy. GPs were informed of the results.

KEY FINDINGS AND LIMITATIONS: From 137 993 text messages inviting 66 911 individuals, 21 905 (33%) completed online surveys and consented to a PSA check. Of 18 317 men with a PSA result, 865 had elevated PSA (4.7%). After 817 mpMRI examinations, 344 patients underwent biopsy, 263 were diagnosed with PC, and 221 had International Society of Urological Pathology grade group 2-5 PC (84% of those diagnosed, 1.2% of those with a PSA test). The detection rate for grade group 2-5 PC was 26% with the age-related PSA cutoffs, and 25% with the ≥3 ng/ml cutoff. The average PC knowledge score increased by 1.87 points after the survey.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The TPHC programme screened men for PC untested during the COVID-19 pandemic without burdening primary care. Men were targeted from at-risk groups and their awareness was raised. Real-world data demonstrate the detection of significant PC via a modern pathway using MRI and LATP biopsies.