The model developed in Chapter 3 was included in an AMS through the MS Excel software, such that serial PSAs could be entered and displayed for men following an AM/AS programme. Interviews with men on AM/AS, urologists and oncologists included a demonstration of the system.

The main interface allows entry of date of birth, Gleason score, PSA test date and result. The Excel sheet then calculates one of a number of options. The first is the average trend of PSA for a similar man (i.e. with the same PSA, age and Gleason score at diagnosis) with clinically localised prostate cancer, as shown in the green line in Figure 10. There is also the option to show the average trend along with 95% reference range for a similar man without PCa, as shown in the blue and orange lines of Figure 10. Using a simple interface, men can compare their own PSA results with the average PSA growth of similar men with and without prostate cancer.

FIGURE 10

The PSARR system for a simulated individual, showing average PSA trend (blue, short dash) plus 95% reference range (orange) for men without PCa, as well as average PSA trend for men with PCa (green, long dash).

Initially, we intended to use the 95% reference range for men without PCa as the method that would alert men with PCa to rapidly rising PSA. After discussion with the steering group, the use of reference ranges of men with PCa were taken forward for use in the comparison of Chapter 5.

Note that data presented are simulated to be indicative of men with PCa. The names given are fictitious and are not representative of any men in any of the cohorts.