Transforming Prostate Cancer Care: Surrey and Sussex Cancer Alliance & Medefer Partnership

The Targeted Prostate Health Check (TPHC) is a new approach to efficiently identify prostate cancer earlier. TPHC has been developed by Medefer and the Surrey and Sussex Cancer Alliance (SSCA). Health Innovation KSS, through their Office of Life Science commission, engaged Unity Insights to evaluate the initial findings of the TPHC programme (data gathered between March 2023 to November 2023).

Challenge

Prostate cancer poses a significant health challenge in the UK, with more than 52,000 cases diagnosed each year. Men aged over 50, Black men, and men with a family history of prostate cancer are at higher risk. The TPHC programme targets men who are most at risk.

The TPHC programme was launched in response to the significant drop in GP visits and hospital referrals for prostate cancer during the COVID-19 pandemic. The TPHC programme aims to improve awareness of prostate cancer, encourage prostate-specific antigen (PSA) testing, increase accessibility, and increase detection rates.

The project links to NHSE’s priorities focusing on earlier diagnosis of cancer and increasing percentage of cancers diagnosed at stages 1 and 2.

Our approach

The TPHC programme uses GP records to identify high-risk men and invite them to have a PSA blood test (known as a case-finding approach). Once a patient is identified with abnormal PSA levels, the TPHC programme integrates with the existing NHS pathways to allow efficient referral to secondary care for diagnostic imaging testing if required.

Health Innovation KSS commissioned Unity Insights to undertake a mixed-methods evaluation to explore whether the TPHC programme improved awareness of prostate cancer, resulted in improved patient outcomes, improved access to prostate cancer testing, and reduced health inequalities.

Note the evaluation covered data gathered between March 2023 to November 2023, and the programme gathered additional data beyond this timeframe

Qualitative insights were gained from analyses of semi-structured interviews with GP practice staff and patient surveys.

Quantitative analyses were conducted on prospective and retrospective data to investigate the impact of the programme on patient outreach, PSA testing activities, and health outcomes.

A cost-benefit analysis (CBA) was also completed to understand the potential return on investment (ROI) offered by the programme.

Key findings

In total, more than 66,000 men across 13 Primary Care Networks (PCNs) were invited to participate in the programme. Eligible men were invited to complete a prostate health questionnaire and discuss having a PSA test.

Key findings from the programme include:

• Increased screening rates: TPHC had an 18% uptake rate, compared to 8% national average (Nderitu et al., 2016).
• The TPHC identified prostate cancer in 1.5% of men tested, including those aged between 45 and 69 years from high-risk groups (such as men of Black ethnicity and those with a family history of prostate cancer) and men aged between 50 and 69 years from lower-risk groups. Through the catchup programme, 263 cases of prostate cancer were identified.
• 83% of participants understood the importance of prostate cancer checks after the programme, compared to 65% in the pre-programme survey, demonstrating the positive educational impact of the TPHC programme.
• The average turnaround time for PSA test results was reduced to 1.25 days, compared to the usual 1-2 weeks, alleviating patient waiting times.

A TPHC Programme GP Interviewee said: “There have been some cancer diagnoses made in which the men were asymptomatic, and they wouldn’t have been picked up otherwise. The fact that it is a non-intimate method of testing has been well-received, encouraging men to come forward who we wouldn’t have normally seen.”

 

Sarah Barker, Innovation Manager, Health Innovation KSS said: “The TPHC programme demonstrates that targeted, efficient screening approaches can make a substantial difference in early cancer detection and potentially in long-term health outcomes for men at risk of prostate cancer. Furthermore, targeted screening programmes such as this have the potential to reduce health inequalities, by reaching underserved communities and encouraging them to come forward for testing.” 

Health and care system impact

The TPHC programme helped increase patient and clinician awareness of PSA testing and understanding of prostate cancer. The programme played a pivotal role in addressing gaps in GP education around prostate cancer screening.

The programme was also found to increase detection of prostate cancer and had faster turnaround time for results, which may lead to men being diagnosed earlier, reducing burden on the care pathway at later stages and potentially increasing survival rates.

Finally, the case finding service was found to be sustainable within the primary care context.

Financial impact

The benefits of earlier prostate cancer detection may be amplified across a larger population than that covered by the study. Although the cost-benefit analysis indicated a negative net benefit of -£206k for the programme undertaken between March 23 – November 23, the impact of national implementation where economies of scale are reached, attained a projected benefit-cost ratio (BCR) of 0.9; equivalent to a £0.9 return for every £1 spent.

Potential scalability

In future, the TPHC programme could be expanded to areas with higher Black ethnicity to further address health inequalities. The evaluation also recommended utilising a cost-utility analysis (CUA) to better understand the economic impact of expanding the TPHC programme to a national level.

Find out more

Read the full report 

Read about the TPHC Programme 

Read about SSCA