Targeted Prostate Health Checks for prostate cancer in men at high risk: a feasibility pilot in primary and secondary care in North East London.

BACKGROUND

Prostate-specific antigen (PSA)-based prostate cancer (PCa) screening risks overdiagnosis and overtreatment. PCa disproportionately affects Black men, those with a family history (FH) of the disease, and BRCA1/2 gene variant carriers. Risk-adapted approaches are gaining interest but are underexplored.

AIM: To assess the feasibility of PSA-based Targeted Prostate Health Checks (TPHCs) for men at high PCa risk, compare invitation methods, and assess sociodemographic variations.

DESIGN &

SETTING

Prospective feasibility cohort study in four primary care networks (PCNs) in North East London.

METHOD: Men aged 45-69 years from Black ethnic group, or with a positive PCa FH, were identified via primary care records and invited by the PCN to one of two TPHCs: (i) telephone-first (phone consultation followed by hospital-based PSA testing); or (ii) test-first (community-based PSA testing followed by phone consultation). Elevated PSA prompted multiparametric magnetic resonance imaging (mpMRI), and prostate biopsy if malignancy was suspected.

RESULTS

Of 2400 invitees, 398 (16.6%) attended. Attendance was higher with the test-first than telephone-first TPHC (22.9% versus 11.2%, P<0.001). Only 51.4% of participants met eligibility criteria owing to inaccurate FH coding, although men who did not meet the eligibility criteria were offered PSA tests. Black men had lower prior PSA testing (55.7% versus 82.5%) and higher deprivation than White men. Elevated PSA occurred in 6.0% of participants (n = 22), with five PCa diagnoses (1.4%).

CONCLUSION

Identification of men at high PCa risk is feasible using age and ethnicity primary care data, but FH coding is unreliable. Test-first invitations improved engagement. Disparities affecting Black men highlight the need for tailored outreach, and better coding of risk factors will facilitate risk-adapted screening.