Implementing the PCN DES - FAQs

FAQs

The below are a series of questions/matters raised from health care professionals in response to delivering the PCN DES specification on prostate cancer.

Shouldn’t I be targeting symptomatic men vs asymptomatic men?

1. Prostate cancer is slow growing and so for many men, they will not have symptoms.

We know that for most men, when they start having symptoms, they tend to be diagnosed at later stage, e.g. stages 3 and 4.

This is of concern to us and so to promote earlier diagnosis and ensure timely diagnosis, we recommend following PCRMP guidance. We also recommend that GPs enable men to have PSA blood tests if they are eligible, fall into one of the 3 risk categories and can make an informed decision about having a PSA blood test.

Clinicians in Bristol have commented that our risk checker tool performs well in providing patients comprehensive information to make an informed choice, if not above and beyond, what a GP might say in a PSA counselling appointment,

2. Changes to the pathway are also reducing some of the harms that men previously experienced

Since the 2019 NICE guidance update, the prostate cancer diagnosis and treatment pathway has changed to make it safer and more accurate. This has meant that men will have a mpMRI scan first and then, if necessary, a trans perineal biopsy. The PROMIS study in the UK showed using mpMRI to triage men might allow 27% of patients avoid a primary biopsy and diagnosis of 5% fewer clinically insignificant cancers.^*1

The move to trans perineal biopsy has also reduced the risk of sepsis.

How do we avoid creating bottlenecks and unnecessary pressure in primary and secondary care?

We have worked with a PCN in Bristol that was in a high deprivation area with a high population of Black men. A total of six practices took part in the pilot.

• They defined three target groups and then sent batch messages for each group on a rotation. This avoided bottlenecks and service was managed over time.

Batch send texts

Batch send text messages into manageable numbers and spread the send over a few weeks – this ensures that if there is a surge in demand, it is possible to simply pause sending new texts until any backlog in PSA blood tests is worked through.

Guide on how to send text messages via Accurx

Better conversion when a nudge text message is sent

People seem to benefit from being sent the text twice 2-3 weeks apart – the spike of risk checker completions was higher on the second text send than the first. 

What age range should we focus on?

We have previously focused on the 45-70 (Black men)  or 50-70 (non-Black men) as beyond 70 there is little evidence of the benefits of intervening, unless men are symptomatic.

We are currently in the process of updating our messaging to 70+ men who take the risk checker. This messaging will make sure it’s very clear that if they have symptoms they should speak to a GP, but otherwise the harms of treatment may outweigh the harms of the cancer. 

People seem to benefit from being sent the text twice 2-3 weeks apart – the spike of risk checker completions was higher on the second text send than the first. 

I have concerns about the PSA blood test as I know it’s not reliable. How can I be sure that I won’t be sending men for unnecessary tests?

The Bristol pilot has found that referrals into secondary care have not been inflated and instead are manageable. They also found that the risk stratified approach meant that the right men were sent for 2ww referrals.

The below data demonstrates the outcome from Bristol, from July – December 2022.

• Approximately 2,626 text messages being sent to men on patient registers
• 913 risk checker completions. 
• 542 PSA tests have been booked
• 16 referrals (several still in system awaiting diagnosis
• 4 definite diagnoses (December 2022).

How do men respond to the risk checker test?

We are aware that many men make a decision that they want a PSA but put off booking it until they are in the GP practice for another reason. Those numbers were from the immediate 6-week period around the texts being sent and the number of PSAs booked may continue to be above average for some time.

How do you manage contacting trans women and what intervention would work best for this population?

We would recommend that practices identify patients who are transwomen and:

1. Send them a letter requesting them to make an appointment to speak to a GP about their risk of prostate cancer, including a link to the risk checker.
2. Have an opportunistic conversation with the patient when they are in surgery.
3. Send a text message to the patient for them to make an appointment to discuss their risk to prostate cancer with their GP.

We have further information for transwomen and risk levels please see this page.