Prostate cancer is the most common cancer in men in the UK, with 1 in 8 predicted to be diagnosed with it during their lifetime.
The UK National Screening Committee (UKNSC) opened a public consultation in November to review new evidence and gather views on implementing a prostate cancer screening service. The review aimed to evaluate the benefits versus the harms of a screening programme, like screening services for other cancers such as breast and bowel cancer. The results of the consultation so far have concluded that evidence still does not support a mass screening programme for the general male population and has instead recommended a targeted screening programme for high-risk individuals. This is the first time the UK has moved towards a targeted screening model for prostate cancer. However, some high-profile campaigners have backed calls for a national screening service.
The consultation process is still ongoing, and feedback has been invited from healthcare workers and the public on the committee’s proposed plan for targeted screening of prostate cancer only. The proposal will now be consulted on for the next three months before the screening committee gives its final recommendations in March.
The committee concluded that evidence does not support a mass screening programme for the general male population because current tests, especially the test for Prostate Specific Antigen (PSA), can lead to overdiagnosis, unnecessary biopsies, and overtreatment. PSA is a protein made in the prostate gland and can naturally be found in the blood stream; elevated PSA levels can signal cancer but may also be caused by other factors such as benign prostate enlargement and ageing.
Who will the targeted screening be aimed at?
The committee has recommended a targeted screening programme, for men who have been identified as having a higher risk of prostate cancer. This would include biennial screening of men aged 45–61 who carry a BRCA1 or BRCA2 gene mutation. Men with this gene mutation have a significantly higher risk of developing aggressive prostate cancer. Around three in 1,000 men have BRCA variants, but many will be unaware unless they have family members that are known carriers and then had it confirmed with a test. Experts say more genetic tests will need to be offered to high-risk men in future, to work out how many are affected.
One of the reasons the committee did not recommend a national screening programme was due to the issues around overtreatment. As tests for the disease are unreliable it could lead to men being treated for a slow-growing cancer that is not likely to cause any harm in the immediate future. The prostate gland is a small gland that is located just below the bladder and surrounds the urethra, due to its location treatment of prostate cancer can lead to urinary incontinence and impotence, both of which can significantly affect quality of life. Whilst finding cancer early can lead to better outcomes and save lives, it can be difficult for doctors to determine which cancers are going to be aggressive and spread and which will be slower growing, which means some men will be treated unnecessarily. The committee said the number of lives saved by screening does not outweigh its harmful effects on healthy men.
There have been calls for other at risk groups to be included in the targeted screening group, for example men of African and Caribbean backgrounds have the highest risk worldwide, having twice the risk of developing prostate cancer, but the committee said there should be no screening for this group due to “uncertainties” around its impact, and a lack of evidence from clinical trials in these men. Similarly, men with a family history of prostate cancer were not included due to fears of too many cancers being over diagnosed and overtreated.
Most men with early-stage prostate cancer will have no symptoms, but when symptoms appear, they are usually related to urinary changes – due to the location of the prostate gland and pressing on the urethra.
Symptoms typically include:
Men can still request a PSA test from their GP if they are concerned, and their GP will then discuss the pros and cons of a test and help assess their risk.
Some 55,000 men are diagnosed with the disease each year, and 12,000 men die from it every year in the UK.
Wes Streeting, the Health Secretary in England, says he wants screening in place but only if it’s “backed by evidence”. He will examine the evidence “thoroughly” ahead of his final decision in March 2026.
Rachel Kayani, Science Tutor and Writer
(Feature photo credit: Science Media Centre/ESP)
