Recent new figures from NHS England show the proportion of patients diagnosed with cancer at an early stage has risen to its highest level on record due to a combination of public awareness and new screening approaches.
Prostate cancer is now the most commonly diagnosed cancer in the UK population, with more than 55,000 new cases diagnosed in 2023. And yet, it doesn't currently have a screening programme.
In 2021 in England, over 22,000 men presented with prostate cancer at stage three or later – when the disease is much harder to treat.
In addition, health inequalities exist for black men, older men and men living in deprived areas. Analysis from the National Prostate Cancer Audit shows that black men are diagnosed with stage three or four prostate cancer at a rate of 440 per 100,000 in England, which is 1.5 times higher than white men. Furthermore, black men in their 60s who had received a later diagnosis were 14% less likely than white men to receive life-saving treatments.
A later stage diagnosis drastically reduces treatment options for men and results in harsher treatments and side effects. But the Faster Diagnosis Standard (FDS) aims to provide 77% of those with suspected cancer a positive/negative diagnosis by day 28 from initial presentation.
How Prostate Cancer UK is supporting NHS trusts
At Prostate Cancer UK, we want every man who has prostate cancer – or is at risk of the disease – to have access to the same high-quality diagnosis, treatment and support, no matter where in the UK he lives.
To do this we want to identify and invest in clinical leaders in the NHS who will transform prostate cancer care and support improvements to the clinical pathway.
In partnership with Living Potential, we run the Clinical Champions Programme which supports clinicians from across the prostate cancer pathway to drive meaningful improvements for men living with or at risk of prostate cancer. We do this by providing training on change leadership, system leadership, improvement science and implementing a project to improve clinical support and services.
The impact of nurse-led clinics in diagnostic standards: a case study
The following case study will present an example from one of our Clinical Champions and lay out the benefits this has resulted in. One of the approaches that has been taken includes the implementation of nurse-led clinics.
As part of our Clinical Champions Programme, Grace, who works at a London-based trust, wanted to utilise and develop the role of the allied nurse practitioner (ANP) to transform the pathway.
Grace's nurse-led FDS pathway model aimed to provide a transperineal (TP) biopsy by day nine, after a telephone assessment, MRI scan and having this MRI reviewed in clinic.
After Grace worked with colleagues to seek extra funding, the team managed to appoint two ANPs in the summer of 2024. Under the supervision of the lead urologist, this team of three ANPs manages the diagnostic pathway.
This team is responsible for undertaking:
- telephone assessment clinics,
- MRI scan review (using AI software to support decision-making),
- MRI results tele-clinics and organising appropriate action (discharge, straight to biopsy, appropriate referral elsewhere),
- biopsy clinics, and histology results clinics.
At Prostate Cancer UK, we want every man who has prostate cancer – or is at risk of the disease – to have access to the same high-quality diagnosis, treatment and support, no matter where in the UK he lives.
Healthcare Improvement Engagement Officer , Prostate Cancer UK
To reflect these changes, and the increased responsibility of the ANP, several standard operating procedures were developed or updated, including TP biopsies and sedation, histology clinic and ANP practice.
Since implementing these changes, Grace's trust has now exceeded the national target in prostate cancer diagnosis rates. In reaching the 28-day FDS, it’s gone from 40% achieved to 88% achieved in just three months.
Despite only hosting one biopsy list a day, the waiting time for direct-to-biopsy patients has decreased significantly from 21 days to three-to-five days, directly supporting and positively impacting 40 patients per week.
This has had a knock-on impact with other urological cancers achieving FDS targets, a rise from 40% to 82% due to more efficient diagnostic pathways.
The impact of a nurse-led service has been very positive, will contribute to supporting FDS in other urological cancers and is properly utilising and freeing up resources.
Within prostate cancer, faster diagnosis means men receive diagnosis and treatment earlier – and those who are diagnosed with late stage disease are looked after better and able to be referred onto further oncology/palliative care services in a timely manner.
Enhancing the diagnostic pathway also creates a more positive patient experience by reducing uncertainty and anxiety for men and their loved ones. Grace’s trust is now a Tier 1 trust.
We're thankful to Grace, her FDS team and her London trust for their hard work in improving their prostate cancer diagnostic pathway for men and their loved ones.
Grace believes that without the support of Prostate Cancer UK and the Clinical Champions Programme, she may have struggled in fully realising the project, with the programme making it possible for her to open doors, reassess her approach and provide a worthwhile service for staff and patients.
What can trusts do?
Faster diagnosis is fundamental to achieving the NHS long term plan's ambitions for cancer – specifically for earlier diagnosis. The plan sets out that by 2028, 55,000 more people each year will survive their cancer for five years or more, and 75% of people with cancer will be diagnosed at an early stage (stage one or two).
Improving your FDS pathway can help you meet the national targets for prostate cancer diagnosis, enhances patient care and leads to the better management of prostate cancer.
By increasing productivity in this pathway, this in turn contributes to increasing capacity in other cancer areas.
Want to improve your trust’s FDS pathway? We can help!
The award-winning Clinical Champions Programme is accepting applications again.
Our free 18-month leadership programme is here to support the next generation of leaders drive transformative improvements in prostate cancer care.
We're accepting applications from passionate, motivated healthcare professionals from across the UK and the prostate cancer pathway to seize this opportunity, developing yourself and your services.
Deadline is Sunday 9 February 2025, 11.59pm
More information is available on our Prostate Cancer UK FDS webpage or email the Improvement Programmes Team.
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