Carl Armstrong
Advanced Nurse Practitioner
Chapelford Medical Centre, Warrington
On average, 144 men a day diagnosed with prostate cancer, and one man dying from the disease every 45 minutes across the UK.
Read what Carl wrote for Pulse here
The Challenge
Prostate cancer is the most common cancer among men, often showing no symptoms in its early stages. Currently, there is no national screening program because Prostate-Specific Antigen (PSA) testing in men without symptoms is problematic. A PSA result can appear normal even when cancer is present or elevated for reasons unrelated to cancer, causing undue stress and leading to potentially harmful, invasive tests. Despite these challenges, Carl, an Advanced Nurse Practitioner at a practice in Warrington, recognised the importance of early prostate cancer diagnosis. He observed that men, particularly those from ethnic backgrounds, were often reluctant to attend screenings and encountered significant barriers in accessing healthcare. Carl aimed to empower men to make personalised, informed decisions about PSA testing, understanding its potential benefits and limitations, and to promote prostate cancer awareness and screening options across his Primary Care Network (PCN).
“The limitations of asymptomatic PSA testing are well recognised, but I strongly believe that men are capable and motivated to make informed personalised decisions about benefits and limitations of this screening test for their personalised circumstances.”
Carl Armstrong ANP
The Innovation
In November 2023, Carl launched a proactive project using guidance from the PCN Directed Enhanced Service and the Prostate Cancer UK Toolkit to identify men at higher risk for prostate cancer. He set specific criteria, excluding men already diagnosed, those on end-of-life pathways, or those who had a PSA test within the past 12 months. Among the 7,910 men in the practice, Carl focused on identifying those aged 50 to 70 at higher risk and Black men over 45, who face an elevated risk. Men with a history of breast cancer or a family history of prostate or breast cancer were also included.
The practice identified 689 men who met the criteria, 37% of whom used the Risk Checker, with 238 choosing to undergo a PSA blood test, and 18 showing abnormal results. Carl reached out to these men via Accurx text, sharing information on symptoms, the risks and benefits of PSA testing, a link to the Personalised Risk Checker, and Prostate Cancer UK counselling resources.
Over four weeks, 90 appointments were offered with two access options:
- Men could directly book a PSA blood test without a consultation.
- Alternatively, they could schedule an appointment with a clinician to discuss any concerns.
A follow-up “nudge” message was sent a week later, reinforcing practice support. Test results were reviewed and managed following National Institute for Health and Care Excellence (NICE) guidelines for suspected cancer referrals. This project increased engagement among men in the practice and raised awareness of other related health issues.
The Impact
- Improved patient access and earlier diagnosis
- Improved patient engagement, awareness and education
- Contributed to the National Early Diagnosis programme
