CCL’s Urology Pathway

I want to be screened for prostate cancer and I have no previous history of prostate cancer

Prostate-Specific Antigen (PSA) – standard screening test

PSA is a protein produced by ‘normal’, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in a man's blood. Elevated PSA levels may be indicative of a prostate issue requiring further investigation. The NHS offer PSA testing to men over 55, however men can develop prostate cancer in their 40s and early 50s. PSA also varies within each individual naturally, so monitoring PSA earlier can help detect any sharper increases in PSA which indicates the need for investigation. PSA is not a perfect test for prostate cancer, as some men will have a normal PSA when they have prostate cancer, and others will have an elevated PSA for other reasons. However, it is the first place to start.

Stockholm3 - advanced screening test

A simple blood test to screen for risk of aggressive prostate cancer, which can be performed on men with PSA as low as 1.5 ng/mL who would not otherwise be detected. It analyses protein markers and genetic information alongside clinical data, giving a risk score and clear directions for further investigation (hisk risk) or to retest in the future (low risk). This test is more accurate than PSA alone, and it may be preferable for those with family history of prostate cancer as it analyses genetic markers.

Proclarix - screening and/or alongside MRI

A simple protein-based blood test that can be done with the same sample as the PSA test. No additional intervention is required with results becoming quickly available. Patients with a PSA level between 2 and 10 ng/ml are in a diagnostic grey zone. Proclarix helps doctors and patients with PSA levels in the grey zone. Its Proclarix Risk Score delivers clear and immediate diagnostic support for further treatment decisions. This test is more advanced than PSA alone.

EpiSwitch PSE

EpiSwitch is a simple blood test which analyses risk of prostate cancer by assessing PSA as well as epigenomic biomarkers. A previous PSA score can be used, or PSA can be run alongside the test. For screening, the test categorizes men into high likelihood (requires MRI), or low likelihood (no further investigation required).

I have had an MRI scan and I need to decide whether to have a biopsy

Proclarix - screening and/or alongside MRI

If your biopsy result was indeterminate, or you want more information before having a biopsy, you can do a Proclarix test. This is a simple protein-based blood test that can be done with the same sample as the PSA test. No additional intervention is required with results becoming quickly available. Patients with a PSA level between 2 and 10 ng/ml and an indeterminate MRI scan are in a diagnostic grey zone. Proclarix helps doctors and patients with PSA levels in the grey zone. Its Proclarix Risk Score delivers clear and immediate diagnostic support to help decide whether to have a biopsy.

EpiSwitch PSE

If your biopsy result is indeterminate, EpiSwitch PSE helps you decide whether a biopsy is necessary. With 94% accuracy, it categorizes patients into low likelihood (no biopsy needed) or high likelihood (biopsy recommended). This test provides accurate diagnoses for 19 out of 20 men and could spare 75% of men from unnecessary procedures or treatments and the anxiety that comes with them.

I have been diagnosed with prostate cancer and I want to know how aggressive it is

Prostatype – after diagnosis

Prostatype®'s unique system identifies the genetic fingerprint of cancer by measuring information from cancer stem cell genes. The gene expressions together with other clinical parameters such as PSA, Gleason and Tumour stage are entered into the Classification of Prostatic Malignancy Algorithm (CPMA) software that is linked to a unique patient data base. The software calculates a P-score which provides a measure of how aggressive the cancer is, facilitating the choice of optimal treatment for the patient.

HRR panel

Used to determine genetic predisposition or as a companion diagnostic tool down the line.

Genetic testing

There are many genetic variants that can be inherited which make certain types of cancers more likely to develop. Having an inherited risk variant, such as the BRCA mutations, is likely to mean your cancer is more aggressive. Therefore, it can be helpful to do a hereditary genetic test to help you and your doctor assess how aggresive the cancer might be.

I want to be screened for Bladder Cancer

Bladder EpiCheck

Bladder EpiCheck is a simple, noninvasive urine test which detects DNA methylation markers in the urine which indicate a risk of bladder cancer. It can be used for screening whether you have symptoms, or whether you just want an advanced screening health check.

I have been diagnosed with bladder cancer and want testing to guide treatment options

PD-L1

Testing is available to clinicians in order to guide treatment options in immunotherapy.

Genetic testing

There are many genetic variants that can be inherited which make certain types of cancers more likely to develop. Having an inherited risk variant, such as the BRCA mutations, is likely to mean your cancer is more aggressive. Therefore, it can be helpful to do a hereditary genetic test to help you and your doctor assess how aggresive the cancer might be.

I have previously been treated for Bladder Cancer and want to advance my surveillance programme

Bladder EpiCheck

Bladder EpiCheck is a simple, noninvasive urine test which detects DNA methylation markers in the urine which indicate a risk of bladder cancer. It is validated for use alongside cystoscopy. You can use it between cystoscopies, or you could use it instead of a cystoscopy, to minimise the number of cystoscopies required.