There were 55,300 new prostate cancer cases in the UK every year from 2017-2019. In the three years from 2022 to 2024, 12,300 people died from the disease, making it the second most common cause of death by cancer among men (after lung cancer).
There is also evidence that black men are more likely to develop prostate cancer, and men from deprived areas are more likely to die from it. But it is also treatable, with around 80 per cent of survivors living for more than ten years if they can get a timely diagnosis and appropriate treatment.
This is why there are calls for a screening programme to detect prostate cancer, similar to breast cancer and cervical cancer screening. The logic goes that the more cancers detected earlier, the faster treatment can be started and the better the outcomes in survival.
However, the debate is complicated by the specifics of how prostate cancer works, with many respected researchers and clinicians arguing that screening is not yet effective enough to warrant the potentially harmful side-effects from treatment on quality of life. These include the risk of lifetime incontinence and loss of erectile function, on top of the general risks from any use of radiotherapy or surgery.
At the end of 2025, the UK National Screening Committee (UKNSC) stopped short of recommending a large-scale screening programme for all people with a prostate (which includes transwomen, some non-binary people and some intersex people).
Instead, it recommended the targeting of men with the BRCA1 or BRCA2 gene variant, which are associated with higher prostate cancer risk, and said the evidence was not yet strong enough to endorse a screening programme targeted at black men, or one for all people with a prostate. It was a controversial recommendation that has since generated significant debate.
Calvin Bailey MP, who chairs the APPG on Prostate Cancer, is frustrated that the targeted screening programme is not including black men. “It’s difficult to understand why. When you can effectively apply pre-screening and reduce the amounts of risk, why can’t that be a thing in and of itself?,” he tells Spotlight.
The diagnosis process has improved in recent years. Historically, if someone thought they might have prostate cancer and were over 50, they could request a prostate-specific antigen (PSA) test, and if the score was higher than average then they would be sent for a biopsy and treatment if that came back positive for cancer.
However, both the PSA test and the biopsy process lacked precision, detecting small low-risk cancers that occur in the prostate, which meant some patients wrongly thought they were in the all-clear while others unnecessarily chose treatment.
In the past ten years, clinicians have started using MRI scans of the prostate to improve accuracy, enabling them and patients to make better informed choices.
“It’s dramatically reduced the number of men who are going through and, in fact, there’s a Göteborg-2 clinical trial, which data from that shows has reduced the amount of overdiagnosis by half. So the MRI scan has been a game-changer in reducing harm,” says Hashim Ahmed, chair of urology and head of the section of specialty surgery at Imperial College London. He believes that the value of a screening programme for everyone has yet to be proven when compared to the harms, which he emphasises have and continue to be reduced.
“The UK is actually quite good at doing something called active surveillance, which is ‘don’t treat immediately, let’s just monitor the cancer, and if it changes in future, you won’t lose the window of curability’. We’ll step in and have treatment at that point,” he says.
Ahmed explains that new “focal” therapies allow for greater targeting of cancers in the prostate and can be used again if the disease comes back. The likelihood of side-effects are also reduced.
“[The] risk of leakage of urine is 1 per cent, not 5-30 per cent with the other treatments, and the risk of erection problems is 5-15 per cent, not the 50-70 per cent – so massive drops,” he says. However, Ahmed believes other treatments using robotics and targeted radiotherapy have yet to deliver the type of improvements he would want
to see.
He is also keen to improve the evidence on prostate cancer among black men, as much of the data comes from studies in the US, which does not have universal free healthcare, he explains. So far, researchers in the UK have not shown enough interest in the experiences of black communities, or adapted their methods to properly engage with them. “There are cultural differences, there are historical reasons why there is distrust in the black community, and we need to do better,” Ahmed says.
“We think there is sufficient evidence both from other trials, more up-to-date trials, real-world evidence in the UK that shows those harms are much less than they’re saying, and the benefits are much greater than they’re saying,” says David James, director of patient projects and influencing at Prostate Cancer Research.
“If you look at the way this has been modelled by the National Screening Committee, they are assuming that 60 per cent of men with clinically insignificant cancer go on to have radical treatments.” James adds that most people with a diagnosis of prostate cancer are now on active surveillance and that the data being used to justify the committee’s decision is out of date.
He also points to the evidence from Lithuania, the only country with a prostate cancer screening programme, which he says shows that screening will “replace and rationalise” the current system and shift diagnoses away from older men (aged 70+) towards younger men, where he says the evidence shows the balance of benefit to harm is far more favourable.
“Overly relying on clinical trial data from two decades ago and being less willing to use real-world evidence from the NHS today is a big crux in our complaints or issues with the way the screening committee has made their decision,” he says.
The challenge may be clear, how to reduce the number of men dying from prostate cancer, and progress is being made both on better diagnosis and better treatments. But researchers and policymakers seem caught between the desire to take bold action and the fear of making the wrong choice. Even if politicians decide to start a large-scale screening programme, it would take time, potentially years, to mobilise the resources and systems necessary.
For Bailey, it is a matter of politicians taking leadership and some political risk on the issue. “All we’re saying is just adjust the screening process and then work out and understand what the consequences of that are,” he says.
Bailey adds that failing to act on these concerns, particularly in black communities, could also reduce trust in the NHS and in politicians. “I think the only way forward is actually to be brave and for someone just to take the leadership on it.”
[Further reading: Why does Keir Starmer even want to be Prime Minister?]
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