HealthTech NHS Prostate Cancer Screening Digital Platform

NHS prostate cancer screening pathway

GP practice list (men aged 50–69 in target area) → invitation letter → PSA blood test (GP surgery or community phlebotomy) → PSA result → if PSA elevated → MRI referral → if MRI suspicious → biopsy.

Digital invitation management

• 1eligibility list (NHS number + DOB from PDS — men 50–69 in pilot area),
• 2invitation letter generation (GOV.UK Notify letter API — printed and posted),
• 3appointment booking (online PSA appointment booking — GP practice or community phlebotomy),
• 4PSA result receipt (laboratory LIMS → FHIR R4 DiagnosticReport),
• 5result letter (GOV.UK Notify — PSA result to patient within 7 days).

PSA threshold

• PSA &gt
• 3.0 ng/mL (NHSE pilot threshold) → automatic MRI referral letter generated.

Prostate cancer screening clinical safety hazards

(1) Elevated PSA result not triggering MRI referral (patient misses cancer diagnosis).

Mitigation

• automated referral on PSA &gt
• 3.0 ng/mL (no manual step), referral confirmation required within 5 days, escalation if no confirmation. (2) PSA result letter not sent to patient.

Mitigation

GOV.UK Notify delivery tracking — undelivered letter triggers re-send and phone call outreach. (3) Patient DNA at PSA appointment — may have cancer.

Mitigation

2 DNA attempts → GP safeguarding notification → reminder letter. (4) MRI result not actioned (radiologist reports MRI, result not communicated).

Mitigation

• MRI result receipt tracking — unactioned result within 7 days → clinical alert.
• All 4 mitigations tested with real clinical scenarios in DCB0129 hazard log.

FHIR R4 integration for prostate cancer screening

• 1PDS FHIR R4 (patient demographics — NHS number, DOB, address for all 50–69 men in pilot area),
• 2NHS eRS (MRI referral — structured FHIR R4 ServiceRequest to urology),
• 3DiagnosticReport (PSA lab result — FHIR R4 DiagnosticReport with SNOMED CT code for PSA),
• 4Observation (PSA value — FHIR R4 Observation, LOINC code 2857-1 for PSA),
• 5EpisodeOfCare (screening episode — from invitation to discharge or biopsy).

NHS DSP Toolkit

DSP Toolkit annual submission includes prostate screening data as a new processing activity — DPIA updated to include pilot programme.

Current pilot

• PSA threshold-based (PSA &gt
• 3.0 ng/mL → MRI referral).
• Future AI pathway (MHRA Class IIa — planned): AI risk stratification combining PSA + age + family history + ethnicity → personalised risk score → risk-stratified referral threshold.

AI design considerations

• 1ethnic risk variation (Black men have higher prostate cancer risk — AI must not apply lower risk threshold for Black men vs white men),
• 2NHS AI Lab Evidence Standards (14 standards — demographic bias testing mandatory for cancer AI),
• 3MHRA SaMD classification (AI influencing referral decision = Class IIa — UKCA marking required before deployment).

Current build

• risk stratification data collected (PSA, age, family history, ethnicity with patient consent) — training dataset for future AI.
• AI not deployed in current pilot.