London School of Hygiene & Tropical Medicine

Last week on 28 November 2025, the UK National Screening Committee (UK NSC), a committee of leading UK cancer specialists, published draft recommendations ahead of a consultation period with ministers that reiterate its current stance against population-based screening for prostate cancer.

As a researcher of prostate cancer, diagnosed with metastatic prostate cancer about 10 years ago, I’m always struck by the power of anecdotal evidence. We heard stories from actors, a sports star and even an ex-prime minister. They said: “I had a PSA test, and my prostate cancer was caught early, and I’m doing well; please introduce screening.” Others said: “My cancer was diagnosed when it had already spread to the bones; screening would have detected it much earlier.” This reasoning can mislead decisions for the entire population.

The UK NSC’s arguments against screening are the obvious ones: the risk of overtreatment and related adverse effects on urinary continence and sexual function are likely to outweigh the expected reduction in prostate cancer mortality. Its accompanying cost-effectiveness analysis also did not find value for money.

The only exception is that screening is potentially recommended for the small group of men who are carriers of the BRCA1 and BRCA2 gene, a genetic variant with a prevalence of around 1 in 300. It is striking that the UK NSC seems to advise against screening other much larger groups who are generally accepted to be at increased risk, including Black men and men with a father or brother with prostate cancer.

Prostate cancer is a “silent” and slow-growing cancer with often no symptoms until it has spread to the other parts of the body and curative treatment is no longer an option. About 60,000 men are currently being diagnosed each year and this number is increasing, with only 12,000 dying because of the disease. Overtreatment, in other words, treating men whose lives are unlikely to be affected by the diagnosis, is a real risk.

But how do the recommendations of the UK NSC fit the reality of today? Many men in their 50s and older will get a prostate-specific antigen (PSA) test, a not very accurate test of the risk of cancer, anyway. For example, as part of investigations in response to urinary problems that men typically experience later in life and are the result of a benign enlargement of the prostate. There is no clear link between the presence of these urinary symptoms and the risk of cancer. Also, a man can have a PSA test after a “conversation” with a GP, even if they don’t have any symptoms. These routes towards a prostate cancer diagnosis explain the gradually increasing number of men diagnosed without symptoms.

The UK NSC had to decide on its draft recommendations in a world in which the way prostate cancer is being diagnosed and treated is rapidly changing.

For example, there are ongoing discussions about how prostate cancer should be defined and whether types of cancer that are unlikely to progress should be excluded. Diagnostic methods are also constantly improving, as are the number of men diagnosed with prostate cancer who can have active surveillance instead of immediate treatment. Treatments are also getting better, especially with a focus on avoiding harm. Follow-up strategies are being tailored to catch men who are experiencing progression of their prostate cancer as soon as possible.

In such a rapidly evolving field, the evidence available to guide these decisions can often be “outdated”, which can lead to a situation where evidence of the past is being used to inform key healthcare decisions for the future.

The UK NSC mentions the UK TRANSFORM trial, a £42 million trial and one the biggest, if not the biggest current undertaking, of prostate cancer screening. This trial started recruitment for its first stage in November 2025 and is expected to recruit in total 300,000 men via recommendation from their GPs and will provide an estimate of the effect of screening on prostate cancer mortality, the harms of diagnosis and treatment, and related costs. It may take some time however, and a lag of 10 years has been mentioned, before the results of this trial will be available. Similar EU-funded initiatives started in several countries the EU one or two years ago, perhaps without the UK included as a result of BREXIT.

Where does this leave us if the recommendations against population-based screening will be confirmed at the end of the consultation period in March 2026?

The current pattern of “opportunistic” use of PSA testing for prostate cancer, after speaking with a GP or when symptoms present, will continue but we need to find ways to make sure every man has equal access to these while other options are considered. A recent LSHTM-based study, published in BMJ Oncology, found evidence of inequity with a much higher incidence of metastatic prostate cancer, the “fatal” type of prostate cancer, in poorer neighbourhoods in England alongside marked geographical variation.

I expect that the discussion around the value of prostate screening will only become louder in the next couple of years.