Prostate cancer screening commands strong public support, with many men and their families pressing for wider access to tests that could catch the disease early. However, the UK National Screening Committee (UK NSC) has concluded that the potential harms of current screening methods remain so significant that a universal programme cannot be justified.
Public support for screening remains high
Prostate cancer is the most common cancer among men in the UK, with around 57,900 new cases diagnosed each year and roughly 12,300 deaths annually. Incidence rates have risen by more than 54% since the early 1990s and are projected to increase a further 14% by 2038–40. Against that backdrop, charities and patient groups have long campaigned for a national screening programme. Prostate Cancer UK expressed disappointment at the UK NSC’s final recommendation, arguing it does not go far enough to address the country’s most common cancer. Chiara De Biase, the charity’s fundraising and health strategy director, noted that the targeted approach would likely screen only a few thousand men each year, leaving many at high risk without a clear route to early detection.
Cancer Research UK, meanwhile, has urged governments to accept the UK NSC’s guidance. Dr Ian Walker, the charity’s executive director of policy, emphasised that screening should only be introduced when the benefits demonstrably outweigh the harms. The Royal College of General Practitioners (RCGP) also acknowledged the limitations of the prostate-specific antigen (PSA) test. Professor Victoria Tzortziou Brown, RCGP President, said a targeted approach was likely most appropriate, though she cautioned that identifying all eligible men would be challenging.
Why widespread screening is judged to cause more harm than good
The core reason the UK NSC has again advised against a population-wide programme is that the PSA blood test, when used on all men, is judged “likely to cause more harm than good.” The committee has published a detailed assessment of the risks, which it says outweigh the modest benefits.
Overdiagnosis and overtreatment are the most serious concerns. Many prostate cancers detected through screening are slow-growing and would never cause symptoms or shorten a man’s life if left untreated. Yet once a cancer is found, men often undergo invasive treatments – surgery or radiotherapy – that carry permanent side effects such as incontinence and erectile dysfunction. Professor Sir Mike Richards, chairman of the UK NSC, explained: “Once a prostate cancer is found, we still can’t reliably tell which cancers need treatment and which do not.” A statistical modelling study cited by the committee suggested that opportunistic screening policies in England have already led to high rates of overdiagnosis and PSA testing.
The PSA test itself is not sufficiently accurate. It can produce false positives, leading to unnecessary anxiety, further tests and biopsies, and can also miss some cancers. Even with advances such as MRI scans before biopsy, the problem of overdiagnosis persists. The committee also noted that while screening may reduce deaths from prostate cancer to a small extent, it does not improve overall survival rates – many men diagnosed through screening would have lived full lives without the disease causing them harm.
Groups previously considered at higher risk have been excluded from the targeted screening recommendation. Black men, who are twice as likely to die from prostate cancer and have a 1 in 4 lifetime risk of diagnosis, face “ongoing uncertainty” about whether screening would do more good than harm. The UK NSC said more research is needed to understand whether Black men are at higher risk of developing fast-growing prostate cancer. Men with a family history of the disease but without a BRCA2 gene variant were also excluded because the evidence suggests screening them would likely cause more harm than good. Similarly, men with BRCA1 gene changes were included in a draft recommendation issued in November 2025 but removed from the final guidance after recent data showed their risk of aggressive prostate cancer is significantly lower than for those with BRCA2 variants.
Chairman’s statement: balancing support and harm
Professor Sir Mike Richards, chairman of the UK NSC, told a briefing: “We absolutely recognise the strong support for prostate cancer screening amongst a large number of people, but also the very real harm that can be caused by the disease which patients, and indeed their families, experience.” His remarks encapsulated the committee’s dilemma: public demand is high, yet the tools currently available cannot distinguish reliably between cancers that will prove lethal and those that will remain harmless.
In place of universal screening, the UK NSC recommends a targeted programme for men aged 45 to 61 who have a confirmed BRCA2 gene variant and a family history of breast, ovarian, pancreatic or prostate cancer. These men would be offered a PSA test every two years. The NHS – and health systems in Northern Ireland – will need to determine the best methods for identifying and inviting eligible men, providing support through screening, and ensuring follow-up tests such as MRI scans and biopsies are delivered safely and consistently. Guidance from the UK Cancer Genetics Group (UKCGG) will be important in this process. The committee acknowledged it could take years for the programme to be fully rolled out across the UK.
Ongoing research and the search for better tests
The UK NSC has stressed that its decision is not final and that it remains hopeful new evidence will support wider screening in the future. The TRANSFORM trial, a £42 million study, is investigating the safest, most accurate and cost-effective way to screen men for prostate cancer, comparing fast MRI scans, genetic testing, and PSA blood testing against the current NHS process. Research into new blood and saliva tests, including a polygenic risk score (PRS) saliva test that has been shown to be more accurate than PSA at identifying future risk for some men, is also under way.
For now, however, the committee’s assessment is that the harms of population-level screening – overdiagnosis, overtreatment, side effects, and the limitations of the PSA test – outweigh the benefits. The targeted programme for BRCA2 carriers represents a cautious step forward, but the vast majority of men, including those in high-risk groups such as Black men and those with a family history but no BRCA2 variant, will not be offered routine screening under these recommendations.
