Graham Fulford Charitable Trust

Welcome to the Graham Fulford Charitable Trust supporting prostate cancer awareness and early diagnosis through PSA testing.

Prostate Cancer - definitions


 There are a number of terms you will come across when reading about PSA tests. We will be adding definitions of the key terms that you will encounter.

We are starting with two of the more common terms: The Gleason Score and Free to Total 

What does the Gleason Score mean ?


 The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread.

3+3 - All of the cancer cells found in the biopsy look likely to grow slowly.

3+4 - Most of the cancer cells found in the biopsy look likely to grow slowly. There were some cancer cells that look more likely to grow at a more moderate rate.

4+3 - Most of the cancer cells found in the biopsy look likely to grow at a moderate rate. There were some cancer cells that look likely to grow slowly.

4+4 - All of the cancer cells found in the biopsy look likely to grow at a moderately quick rate.

4+5 - Most of the cancer cells found in the biopsy look likely to grow at a moderately quick rate. There were some cancer cells that are likely to grow more quickly.

5+4 - Most of the cancer cells found in the biopsy look likely to grow quickly.

5+5 - All of the cancer cells found in the biopsy look likely to grow quickly.
Your doctor or nurse will talk you through what your results mean.

Source: Prostate Cancer UK 

Free to Total - Testing free and bound PSA



A standard PSA test measures the total PSA in the blood. But PSA has different forms. It can either be
Bound – attached to a protein in the blood
Free – not attached to a protein

We know from research that the proportions of free and bound PSA are different in men with prostate cancer, compared to men who have benign prostate disease. The general opinion is that a higher amount of free PSA in a test means a lower chance of cancer. Many doctors think that if more than a quarter (25%) of the total PSA is free, there is less chance of having prostate cancer. Put another way, men with prostate cancer are thought to have a lower proportion of free PSA.

So it is possible this test could help doctors find the cause of a raised PSA level. This might mean that some men with benign conditions avoid unnecessary biopsies. But methods of testing free and bound PSA in laboratories vary. And doctors are not agreed on the ratios of free to bound PSA that indicate cancer. So it is not used routinely in diagnosing prostate cancer. You are more likely to have it done if your standard PSA test result was borderline. 

Boston Scientific


SpaceOAR Hydrogel


SpaceOAR hydrogel is a clinically proven, minimally invasive spacer designed to minimise urinary, sexual, bowel side effects and protect quality of life for prostate cancer patients undergoing radiation therapy.Prostate cancer is currently one of the most common cancers in the UK; more than 40,000 cases are diagnosed each year. Typical treatment plans include a high dose of radiotherapy that aims to effectively kill cancer cells so they cannot spread any further.Due to the prostate being close to other organs and tissues, such as the rectum, there is a risk of long-term damage and side effects such as rectal pain, bowel and urinary leakage and sometimes erectile dysfunction.

New gel solution can reduce side effects of radiotherapy

SpaceOAR Hydrogel, a NICE approved water-based hydrogel spacing device, available across the UK via private and co-pay providers has recently been adopted by NHS England’s Innovation Programme. Inserted via a fine needle into the space between the prostate and rectum, under anaesthetic, the gel fills the cavity between the prostate and rectum, creating about 1cm of space. This allows the oncologist to optimise the delivery of radiation to the prostate and reduce exposure to surrounding healthy tissues. The only prostate-rectum spacing device to be supported by a 222-patient randomised control trial and over 50,000 implants world-wide, this has had very positive patient outcomes.

Professor Amit Bahl is the Consultant Clinical Oncologist and Clinical Director based at The Bristol Haematology and Oncology Centre and was the first to use this new technology when it became available on the NHS Innovation Technology Programme (ITP) earlier in the spring.Professor Bahl says: “When looking at treatment options, the risks of these procedures are low but it’s understandable that patients are worried about them when they include terms such as ‘rectal toxicity’.

Together with worries over erectile dysfunction or urinary incontinence, it can make the choice between radiotherapy and surgery quite tough.

“Now, I am able to say to patients that I can perform a small procedure that will reduce these side effects and minimise radiation exposure to healthy organs and tissues. I haven’t had anyone turn it down yet.”

A 15-20-minute treatment under anaesthetic

The treatment itself is very simple and takes around 15-20 minutes as a day procedure, under general or local anaesthetic, depending on the patient. Professor Bahl explains: “Essentially, it is a fine needle through the perineum, into the peri-rectal fat. The idea is to dispense the gel between the posterior part of the prostate and the anterior part of the rectum, where the prostate touches the rectum. The gel then forms a soft spacer to separate these tissues. Once the patient has undergone radiotherapy, the gel is broken down by the body and naturally absorbed in about six months.”

More information can be found at