The Man Van phase 2 results: Mobile targeted case finding for prostate cancer.

Abstract

317 Background: Early intervention is potentially lifesaving in prostate cancer and is a major limitation of cancer outcomes with ethnicity and deprivation being determinants of inequalities that impact outcomes. The Man Van is designed to address health inequalities and barriers to accessing healthcare that affect prostate cancer with novel community-based targeting of high-risk groups using a mobile clinical unit. These inequalities are particularly relevant for men from ethnic minorities and lower socio-economic groups. Methods: A bespoke nurse-led mobile clinical unit was moved to community-based locations in areas of high deprivation indices in London (UK) with targeted invitations to high-risk men. Men were offered prostate-specific antigen (PSA) tests and a general health check including: blood pressure, body mass index and an HbA1c test for diabetes. Results: Between January 2023 and January 2024, 3379 men attended a Man Van clinic (non-attendance rate 15.1%). The median age of attendees was 59 years (range 39-97). 36.4% of attendees were non-White including 16.7% of men who were Black. The median IMD rank was within the 6 th lowest decile. 310 men were referred for prostate cancer investigations, 262 had prostate MRI scans. 139 (53.1%) of MRIs were PIRADS 1/2, 35 (13.4%) PIRADS 3, 85 (32.4%) were PIRADS 4/5. 3 (1.1%) scans could not be scored. 127 patients underwent a prostate biopsy (48.5% of men having an MRI scan), with 94 prostate cancers diagnosed (74.0% of biopsies). 81 (86.2%) of these were cancers with clinically significant disease, being grade group 2 (i.e. Gleason 7) or higher (all with >5% pattern 4 Gleason scores). The overall diagnostic rate of clinically significant disease was 2.8%. No prostate cancers were metastatic at presentation, with only one being T4. Of the men diagnosed with prostate cancer (N=94), 25 (26.6%) were managed with active surveillance, 2 (2.1%) were managed with cryotherapy, 2 (2.1%) were managed with low dose-rate brachytherapy, 39 (41.5%) underwent robotic prostatectomy and 26 (27.7%) underwent radiotherapy. 59 patients were referred on two week wait pathways for haematuria (visible or persistent non-visible). One bladder cancer (TCC) was diagnosed (G3pT1bN0M1). 43 patients (2%) were diagnosed with diabetes, 207 patients (11%) with pre-diabetes. Conclusions: The Man Van initiative is a novel method of linking primary and secondary care for a range of health checks, including PSA. With a streamlined and more efficient service we have maintained high uptakes for health checks a willingness to engage with health improvement measures from deprived and ethnic minority groups. As well as comparatively high levels of prostate cancers diagnosed at early stages, high levels of other health conditions were found; improving the economic value of the service. Clinical trial information: NCT06357416 .