Routine prostate cancer screening should not be introduced for the majority of men in the UK, according to a draft recommendation from the UK National Screening Committee (UKNSC). The panel concluded that population-wide testing using the prostate-specific antigen (PSA) blood test is “likely to cause more harm than good”.
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The decision comes as researchers await early findings from a major new trial, launched last week by Prostate Cancer UK, examining whether PSA results combined with rapid MRI scans and genetic testing could ultimately justify a nationwide screening programme.
For now, the committee is recommending regular screening only for men who have BRCA1 or BRCA2 gene mutations — a group at significantly higher risk of developing the disease. Under the proposals, these men would be screened every two years between the ages of 45 and 61.
Health Secretary Wes Streeting, responding to the draft, said the Government would study the evidence carefully. While he remains committed to earlier diagnosis and quicker treatment, he emphasised the need to weigh those ambitions against “the harms that wider screening could cause”.
Prominent public figures including Sir Chris Hoy, Lord David Cameron, Sir Stephen Fry and Sir Tony Robinson — all of whom have been treated for prostate cancer — expressed disappointment at the cautious approach.
Professor Sir Mike Richards, former national cancer director and chair of the UKNSC, said modelling shows PSA screening may reduce deaths slightly, but the rate of overdiagnosis is so high that it outweighs the benefits. A raised PSA level does not necessarily indicate cancer, while many aggressive cancers occur even when PSA levels appear normal. False positives often lead to unnecessary treatment, exposing men to potential complications such as incontinence and erectile dysfunction.
The committee also rejected broad screening for black men, who statistically face twice the risk of developing the disease, citing a lack of robust data specific to this group. Likewise, targeted screening for men with a family history of prostate cancer was not recommended, although the committee plans to work with Prostate Cancer UK’s new Transform trial to gather further evidence.
Transform — a £42m research programme — is testing whether combining PSA, genetic markers and ten-minute MRI scans could make screening both accurate and safe enough for routine use. Findings are expected within two years.
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Laura Kerby, chief executive of Prostate Cancer UK, said many families would find the draft recommendation disappointing. “People are exhausted by seeing the men they love harmed by this disease,” she said. “While screening BRCA carriers is a step forward, it will save only a fraction of the lives a mass screening programme could protect. We remain determined to change that.”
Cancer Research UK said it supported the UKNSC’s conclusion that screening for most men remains premature. Dr Ian Walker, the charity’s executive director of policy, said there was still not enough high-quality evidence to show that PSA-based screening would deliver more good than harm for the wider population.
Mr Streeting reiterated that the Government would review the recommendation thoroughly before its final publication in March, adding that the Transform trial has “the potential to revolutionise” screening.
At present, around three in every 1,000 men carry BRCA gene mutations, and the UKNSC is working with the NHS to improve methods of identifying carriers — who often only learn of their status through genetic testing of female relatives with breast cancer.
Men with a strong family history of prostate cancer can still request a PSA test via their GP, but the committee cautioned that more evidence is needed before extending screening to these or other high-risk groups, including black men.
The charity Prostate Cancer Research described the draft recommendation as a “missed opportunity”, arguing that earlier concerns about unnecessary biopsies are less relevant now that MRI-first techniques are becoming standard practice. Its chief executive, Oliver Kemp, said the decision “does not go far enough”.
Figures published by the UKNSC indicate that approximately 80 per cent of men diagnosed through PSA screening would not benefit in terms of reducing their risk of advanced disease or death.
Several high-profile figures, including Sir Tony Robinson and broadcaster Dermot Murnaghan, have voiced their disappointment. World Cup winner Sir Geoff Hurst said he believes annual or bi-annual PSA testing for men over 45 “should be mandatory”.
Professor Bernard Rachet, who leads the Inequalities in Cancer Outcomes Network at the London School of Hygiene & Tropical Medicine, welcomed the UKNSC’s stance. “The evidence is strongly against PSA-based screening in the general population,” he said, noting that the decision aligns with guidance in countries such as Denmark, where PSA testing among men without symptoms is strongly discouraged.
