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

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