A roster of high profile advocates, including sportsmen, actors, two previous prime ministers and over 100 MPs, have recently joined patient groups and charities in calling for a UK national prostate cancer screening programme.
Author
- David C. Gaze
Senior Lecturer in Chemical Pathology, University of Westminster
However, the UK National Screening Committee (UKNSC) has announced its draft decision to advise the government against routine population screening for all men. It has also rejected calls for a specific screening programme for black men due to "uncertainties" given the lack of clinical trials in this population group.
Instead, it recommended targeted screening every two years for a small proportion of men - those aged 45 to 61 years with a confirmed BRCA1 or BRCA2 gene mutation. Three in every 1,000 men carry these gene variants and may develop faster-growing and more aggressive cancer at a younger age.
Why such caution?
The UK screening committee commissioned the Sheffield Centre for Health and Related Research (Scharr) to model the cost-effectiveness of prostate cancer screening. It looked at screening all-risk men, black men, men with family history of cancer and BRCA carriers. Its initial findings were that screening for BRCA carriers was the most cost-effective, and there was the most uncertainty about screening all-risk men.
These findings reflect limitations with the way screening would be carried out. The evidence shows that the standard blood test used for early detection, the prostate‑specific antigen (PSA) test, is not accurate enough when used as a general screening tool .
The PSA test often fails to distinguish between cancers that would cause serious illness and those that would remain harmless for a man's lifetime, such as a benign enlargement of the prostate called benign prostatic hyperplasia or BPH. That means screening with PSA alone could result in false positive tests.
As a result, many men could face invasive follow-up procedures or treatments, including surgery or radiotherapy that carry serious risks, such as incontinence and sexual side-effects, even when their cancer posed little threat. Conversely, the PSA test may also miss some cancers (called "false negatives") with dangerous health consequences if not detected and appropriately treated.
Compounding the problem is a lack of convincing evidence that mass screening reduces the number of deaths from prostate cancer. The UKNSC has so far concluded that the balance of harms and benefits does not support a nationwide screening programme.
That said, the committee recognises the debate is not over. Screening proponents point to newer data. A recent study in the BMJ showed that PSA-based screening could reduce prostate cancer deaths by about 13% over time.
Meanwhile, advances in technology have improved diagnostic pathways. Many men with high PSA levels are now offered an MRI scan before biopsy, reducing unnecessary biopsies and the risks associated with them .
Assuming the government follows the committee's advice, what this means for now in practical terms is that most men in the UK will not be invited for regular prostate cancer checks. The only widespread option remains the "informed choice" route, where men aged 50 years or over who want a PSA test can ask their GP, but even then, they should be informed of the possible risks as well as the benefits of testing.
However, this may not be the end of the story. The committee has opened a consultation on its draft recommendation and on the Scharr study. It is due to make its final recommendation in March 2026. It has also commissioned Scharr to undertake further modelling.
The health secretary, Wes Streeting, who will make the final decision on screening, said: "I will examine the evidence and arguments in this draft recommendation thoroughly, bringing together those with differing views, ahead of the final recommendation in March."
The week before the recommendation was announced, a major two-year trial was launched to assess and compare different screening methods, including fast MRI scans, genetic testing and PSA blood testing.
But until screening can reliably tell harmful cancers from harmless ones, the risk of overdiagnosis and overtreatment will remain a real and serious concern.
David C. Gaze does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
