# Charity-Provided Community-Based PSA Testing for Assessment of Prostate Cancer Risk in the UK: Clinical Implications and Future Opportunities

## TL;DR

A UK charity's community-based PSA testing program helps identify men at high risk for prostate cancer, showing promise for improving early detection.

## Contribution

The study evaluates a community-based PSA testing model's effectiveness in identifying high-risk prostate cancer cases compared to existing risk tools.

## Key findings

- Men in the red risk category had over 15-fold higher odds of clinically significant prostate cancer compared to the green group.
- The GFCT traffic light system showed good predictive ability with an AUC of 0.76, comparable to the Riskman score (AUC 0.84).
- The GFCT model supports shared decision-making and complements national screening research efforts like the UK TRANSFORM trial.

## Abstract

Prostate cancer is the most common cancer in UK men, yet the lack of a national screening program results in inconsistent early detection. The Graham Fulford Charitable Trust (GFCT) delivers community-based PSA testing to improve access and awareness. This study analysed GFCT data from 2021 to 2024 to evaluate how well its traffic light risk system identifies men at increased risk. The model uses age-specific PSA thresholds and groups individuals into green, amber, or red risk categories. Men in the red group had over 15-fold higher odds of clinically significant cancer (Grade Group ≥ 3) compared to those in the green group. Based on self-reported data collected in this survey, the GFCT approach performed comparably to other approaches, such as the multivariable “Riskman” score, which had a slightly higher AUC (0.84 vs. 0.76). Riskman benefited from integrating the PSA free-to-total ratio. The GFCT now performs over 50,000 tests annually and is evolving to include reflex biomarkers and GP follow-up options, supporting shared decision-making. Whilst not a substitute for formal screening, the GFCT model complements research efforts like the UK TRANSFORM trial and highlights the potential of low-cost, community-based approaches to improve early detection of high-risk prostate cancer.

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.