Prostate matters is a not for profit organisation committed to providing free information about prostate issues from leading Clinical Authorities.

Stockholm 3 – What to do if you have a high risk score – The NHS route

Mr Alan Doherty Copnsultant Urological Surgeon

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If you are visiting the page you have had the results of your Stockholm 3 test, followed possibly by a DRE or prostate volume measurement, which indicate that there is a high risk of you having prostate cancer.

The first thing to say is to try not to be anxious, you have time to consider your options and what you wish to do.

Get referred to the NHS 

In all cases there is an an initial obstacle in the NHS, you need to overcome, which is you need a referral from your GP.  Your GP will probably never have heard of Stockholm 3, he or she will be used to referring patients based on PSA results.

To overcome this obstacle we have developed a pro forma letter to your GP in word which you can edit to add the GP and your name and present to him or her along with your Stockholm 3 results. You can of course ask to be referred to your local urology department, or to a particular Urological Surgeon and department using the NHS  ‘Choose and Book’, e referral system or choose a private option.

In England, it is your right to use the the ‘NHS Choose and Book’ system using the NHS e-Referral Service to be referred to the Urology department and Urological Surgeon of you choice, in Scotland, Wales and Northern Ireland the situation is not the same but we understand there are similar rights within those countries.

 The assumption is if you are on this page you wish to enter the prostate cancer diagnostic pathway via the NHS.

Regardless of which route you choose, NHS or the private route, (and you can switch between them) the first step on the diagnostic journey will be an MRI. Be aware  MRI and its reporting vary in quality. Typically, large regional NHS Trust hospitals and the London Teaching hospitals provide decent MRI quality which is well reported. This is not necessarily the case with smaller Trusts. Therefore we recommend you use the eBooking/Choose and book system to get your GP to refer you to a regional centre. If you wish, browse the Clinical panel and choose a particular Urological Surgeon as well as Trust if you wish.

See the link below.

Similarly, treatment options you might be offered if necessary are far from the same in every hospital. This is discussed in more detail later in this section.

As to the time to complete the diagnostic process, not many hospitals, private or NHS complete the diagnostic pathway in 28 days. Somewhere between 30 and 40 days is more the norm.

You can read about the steps on the diagnostic  pathway by following the link below the link below. The link page will open in a separate window, so you can study it and switch back to this page.

The results of an MRI, which, when reported will give an indication of the possible cancer lesions and their position in the prostate. Results from this MRI and report will determine whether you need a biopsy.

You can read more about the MRI and how it is reported and scored by clicking on this link. Once again it will open in a separate page, so you can study the those pages and return here. It will also tell you which Trusts are compliant with the Promis standard, a minimum quality standard for MRI  and reporting of prostate cancer.

Finally, there is also a link to pages explaining  prostate biopsy and what the results mean if it is determined that you need one.

What if, following biopsy reasults, I need treatment?

Most NHS hospital will only offer Radical Prostatectomy or Radiotherapy of some sort. Not all offer Active Surveillance and very few offer focal therapy which has the least side effects for suitable patients. Focal therapy centres are are few and far between and travelling may be difficult. With this in mind, remember you can always ask to be transferred after MRI results are reported and you have had biopsy results to a different hospital using the ‘Choose and Book’ system. If you would like to explore the possibility of being referred to a hospital offering focal therapy, the charity Prost8 will always help you with this. Typically if you are diagnosed after biopsy Grade Group 1 (Gleason 6) 0r Grade Group 2 a or b  which equates to Gleason 3 + 4 = 7 you may well be suitable for Focal therapy and in the case of Gleason 6, Active Surveillance. In some cases with an isolated lesion it may be possible to treat Gleason 4+ 3 = 7. More likely though you will need external beam radiotherapy or a Radical Prostatectomy

If you want to learn more about  the treatment options for prostate cancer, the treatments section of the website gives a comprehensive description of all the options. See link below.

NHS Hospitals with good MRI and biopsy that offer all treatment options

As you see this is a very short list. Therefore to remind you, if following MRI and biopsy you are told you need treatment and you results indicate Grade Group 2 cancer = Gleason 3 + 4 = 7, you can ask to be referred to one of these hospitals as you may be suitable for Focal therapy. Prost8 will help with this.

If you are lucky enough to live near one of these NHS Trusts, or you do not mind travelling, you can start you NHS journey with them from the beginning.

Note we have also included NHS Trusts who will be offering Focal therapy in the future. They will at least be sympathetic to that option.

University College Hospitals NHS Foundation Trust (UCLH), London

Charing Cross Hospital, Imperial College Healthcare NHS Trust, London

Hampshire Hospitals NHS Foundation Trust, Basingstoke

University Hospitals Southampton NHS Foundation Trust

Royal United Hospitals Bath

The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust

Victoria Hospital Kirkcaldy NHS Fife

The charity Prost8 have a program to establish focal therapy centres in other  hospitals such  that they can offer all treatment options.

We will update this page when they go live.

We anticipate these will include in the near future:

Kings College Hospital, South London

and Leeds Teaching Hospitals NHS Trust

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Prostate matters is a not for profit organisation that is committed to providing free expert advice about prostate issues from leading Clinical  Authorities

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