Optimising Primary Care Risk Stratification for Clinically Significant Prostate Cancer: ProsDetect II

PI Title: Garth Funston

Lead member: QMUL

Prostate cancer is the most common cancer in the UK - each year 55,000 men are diagnosed and 12,000 die from the disease.
It is more common in Black men than White or Asian men. Diagnosing aggressive types of prostate cancer earlier could help people live longer, healthier lives.
Prostate cancer is usually picked up when men have a blood test called Prostate Specific Antigen (PSA) at their GP’s, either because they have symptoms e.g. passing urine more often, or just want a prostate cancer check. However, PSA is not perfect – it can be normal in some men with prostate cancer and abnormal in some without prostate cancer. This can delay
diagnosis and treatment for those with the disease and cause unnecessary referrals and tests in some without the disease.
Our research shows that some age and ethnic groups are at higher risk of prostate cancer than others, at the PSA levels at which men are currently referred to the hospital for further cancer testing. This could lead to avoidable inequalities in cancer detection e.g. more cancers being missed in some groups of men.

This project aims to improve the quality of care for hundreds of thousands of people tested for PSA in general practice. We will focus on improving how we pick up aggressive prostate cancer in different age and ethnic groups. We will also study the harms and benefits of PSA testing, as well as what information people need to make the right decision for them about whether to have a test.
Firstly, we will use anonymised medical records from over 1 million men to study whether using different PSA levels for referral could help us better pick up prostate cancer across age and ethnic groups. Secondly, we will study the health impact and costs of using these new PSA levels within the NHS. Thirdly, we will use anonymised medical records to build a tool that combines all PSA tests a man has had over time with other health information. This tool may be better at picking up aggressive prostate cancer than a single PSA test. Fourthly, we will study medical records to understand harms and benefits of PSA tests in men who may be less likely to benefit, due to age or other conditions. We will interview men aged over 80 years to learn what information they need to make decisions on PSA testing. This is important as these men frequently have PSA tests but are usually excluded from prostate cancer research.

This project has been co-developed with patient representatives who will play a central role throughout the project. To reach a wide audience we will share findings through research papers, public facing articles and the media.