Background:Prostate cancer is the most common malignancy among UK men, yet the lack of a national screening program creates disparities in early detection. PSA testing during primary care is inconsistent, limiting timely diagnosis. The Graham Fulford Charitable Trust (GFCT) and its associated support groups offer community-based PSA testing to help bridge this gap.Objectives: This study evaluates GFCT’s historical testing records and a participant survey (2021–2024) to assess their community-based PSA testing program, which is widely used and offers shared decision support. Additionally, we examine the GFCT’s alignment with emerging initiatives such as the UK TRANSFORM trial and other PSA screening developments across Europe and the USA.Methods: The GFCT systematically collects PSA testing data, conducting over 50,000 tests annually. The study assesses the performance of their traffic light scoring system and a previously defined combination algorithm, “Riskman”, which incorporates PSA, PSAft%, and age to classify individuals into risk categories. Multivariable logistic regression was used to evaluate and compare the predictive performance of each approach.Results: Based on the self-reported data in the survey, the GFCT’s traffic light system—using age-specific PSA thresholds to assign green, amber, or red risk—showed good predictive ability. Men in the red group had over 15-fold increased odds of clinically significant cancer (Grade Group ≥ 3) compared to those in the green group. While the Riskman score achieved a higher AUC (0.84 vs. 0.76), both tools were effective in identifying high-risk individuals.Conclusions: This study highlights the GFCT’s role in improving access to PSA screening and integrating practical risk stratification. Its alignment with evolving screening initiatives demonstrates the value of community-based, data-driven approaches for earlier detection of aggressive prostate cancer.
背景：前列腺癌是英国男性中最常见的恶性肿瘤，然而由于缺乏国家筛查计划，早期检测存在差异。初级保健中的PSA检测实施不一致，限制了及时诊断。格雷厄姆·富尔福德慈善信托基金（GFCT）及其相关支持团体提供基于社区的PSA检测，以帮助弥补这一差距。 目的：本研究通过评估GFCT的历史检测记录和参与者调查（2021–2024年），对其广泛使用并提供共享决策支持的社区PSA检测项目进行分析。此外，我们还探讨了GFCT与新兴倡议（如英国TRANSFORM试验）以及欧美其他PSA筛查进展的契合度。 方法：GFCT系统收集PSA检测数据，每年进行超过50,000次检测。本研究评估了其交通灯评分系统及先前定义的组合算法“Riskman”的性能。该算法结合PSA、PSAft%和年龄将个体分类至不同风险等级。采用多变量逻辑回归评估并比较各方法的预测性能。 结果：基于调查中的自我报告数据，GFCT的交通灯系统（使用年龄特异性PSA阈值分配绿色、琥珀色或红色风险）显示出良好的预测能力。与绿色组相比，红色组男性患临床显著癌症（分级组≥3）的几率增加了15倍以上。虽然Riskman评分获得了更高的AUC（0.84对比0.76），但两种工具均能有效识别高风险个体。 结论：本研究强调了GFCT在改善PSA筛查可及性和整合实用风险分层方面的作用。其与不断发展的筛查倡议的契合性，证明了基于社区、数据驱动的方法在早期检测侵袭性前列腺癌方面的价值。
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