Review advises against broad NHS prostate cancer screening

The UK's National Screening Committee has concluded its review of prostate cancer screening in the UK, saying that the harms of a large-scale, national programme would outweigh the benefits.

The outcome was anticipated, after the preliminary funds of the review were disclosed last December, and – despite pushback from patient organisations during a consultation period – the NSC has narrowed its recommendations.

Now, the UK government has to decide whether it will accept the advice to reserve screening only for "a few thousand" men with BRCA2 mutations that elevate their risk of prostate cancer, or offer it more widely. Men with BRCA1 mutations are not included in the final version, although they were in the earlier draft.

Men with BRCA2 mutations only between the ages of 45 and 61 should have screening based on a PSA blood test every two years, said the NSC. It has recommended against testing of the general population, as well as other groups at higher risk of prostate cancer, including Black men and those with a family history of the disease.

The main harms attributed to screening include incontinence and erectile dysfunction if a man undergoes an unnecessary biopsy or treatment based on the result of a PSA readout, which can also be elevated due to other benign prostate conditions. For Black men, "there is ongoing uncertainty as to whether screening would cause more good than harm," according to the review.

The NSC has calculated that for every 1,000 men screened in their 50s, it would save two lives from prostate cancer over the following 15 years, but lead to 20 men being told they have a cancer that would never require treatment.

Simon Grieveson, assistant director of research at Prostate Cancer UK, said the charity is "deeply disappointed" by the recommendation, which follows a high-profile campaign arguing for widespread screening, supported by the likes of former Prime Minister Rishi Sunak, Olympic cyclist Sir Chris Hoy, and actor and broadcaster Sir Stephen Fry.

"We recognise there is still not enough evidence to support screening for all men at risk, however, Prostate Cancer UK is rigorously scrutinising the evidence behind today’s decision and will challenge it where we disagree," added Grieveson.

"We know that more must be done to save the lives of men with prostate cancer, and we have to start with men at highest risk of the disease, including men with family history and Black men."

Some experts, including Dr Adam Brentnall, a biostatistician at Queen Mary University of London (QMUL), have questioned the data on which the recommendations have been drawn.

According to Brentnall, the model that was used in the draft recommendation released last year included "substantial miscalibration of UK prostate cancer incidence by age, and prostate cancer mortality by age" and may have overestimated the harms of screening.

At the same time, other experts, such as urology specialist Prof Hashim Ahmed of Imperial College London, argue the NSC had arrived at the right conclusion.

The outcome "reinforces what the data has consistently shown – that currently the harms unfortunately outweigh the benefits of population-level screening for most high-risk groups and the population as a whole," according to Ahmed.

That view was echoed by Cancer Research UK's policy director, Dr Ian Walker, who said: "the PSA test currently used to help detect prostate cancer isn’t effective enough to support wider screening, as shown in multiple large-scale trials."

It's worth noting, however, that the recommendations are not set in stone, as the NSC has said the modelling study will remain 'open' so that additional findings can be taken into account.

Evidence may be generated by a £42 million ($55 million), large-scale TRANSFORM study, for example, which started in 2024 and is testing various approaches to prostate cancer screening, including MRI pathways and saliva-based genetic testing.