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Scientists comment on the ‘Prostate Cancer Screening: The Impact on the NHS’ report, published by Prostate Cancer Research.
Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, said:
“The question ‘can we afford it’ is not the main barrier to screening in the UK. The crucial question that determines whether we can achieve prostate cancer screening is whether the benefits of screening outweigh the harms.
“We know that the diagnostic pathway has improved in recent years – we funded some of the key research that delivered those improvements, and that is why three years ago we requested the National Screening Committee review the latest evidence for targeted screening. What isn’t known is the number of men harmed per life saved with our current pathway. The National Screening Committee has commissioned specialist teams to build a model that will answer this primary question of harm to benefit ratio. It will also give a more robust answer to the question of affordability – one that looks at the full costs of the repeated screening and the subsequent treatments that will be necessary to deliver any benefits from a screening programme. The current report does not do that and so the headline figure of £18 is incorrect. Presenting incomplete evidence as fact confuses decision makers and upsets men with prostate cancer. It is essential that decisions by and on behalf of men are based on evidence that is as complete and robust as possible, otherwise we risk causing harm and saving fewer lives than we could. The publication of the National Screening Committee’s model and evidence review will hopefully soon give us that complete and accurate picture on where we stand today.
“Whatever the National Screening Committee decides, we know that there will be many men with aggressive cancer missed by current testing. An effective screening programme for all men at risk of prostate cancer is crucial and urgent. To deliver that we will need new tests that save more lives. The only way to bring those new tests into the clinic is through research, and that is why Prostate Cancer UK has funded the £42m TRANSFORM trial. TRANSFORM will begin producing new evidence within the next two years. The National Screening Committee has committed to reviewing the new evidence at that point and continually throughout the life of the trial. Ultimately, TRANSFORM is the only way we will get evidence for a future way of diagnosing prostate cancer that takes us beyond what we can do for men now.”
Prof James Catto, Professor of Urology at the University of Sheffield and an Honorary Consultant Urological Surgeon at Sheffield Teaching Hospitals NHS Trust, said:
“Prostate cancer is the commonest male cancer in the UK and the second most common cause of cancer death in men. In most men, prostate cancer is a slow growing disease that does not become apparent within their lifetime. We know that we can find prostate cancer, if we use the PSA blood test and MRI scans. The challenge is to find those cancers that would affect that man during his lifetime (either through symptoms or death). We don’t yet know the best approach to do this. Previous trials of prostate cancer screening have found too many men with the slow growing cancers, and have led to potential harm (from treatment of those cancers). In the UK, there are two trials about to open that are testing new approaches to detecting prostate cancer – trying to focus on the most aggressive cancers. The TRANSFORM trial will compare 4 different ways to diagnose the cancer, with no screening. The IMProVe trial will compare different PSA values and modes of. MRI scanning in the community in Yorkshire. Whilst neither will answer the question quickly, it is better to find the best approach rather than start testing immediately and risk harming men and overwhelming hospitals. “
Prof Nick James, Professor of Bladder and Prostate Cancer Research, Institute of Cancer Research (ICR), said:
“The case for PSA screening for prostate cancer gets increasingly strong. The previous concerns around overdiagnosis and overtreatment can be mitigated by use of MRI pre biopsy which eliminates the needs to biopsy at least 50% of men. Of those that we know biopsy we can target the relevant areas of the prostate. If men are diagnosed with a clinically low risk prostate cancer, they can be monitored and the pre biopsy MRI gives us an accurate baseline for further monitoring.
“The National Screening Committee is reportedly set to reject blanket PSA screening, despite the changes in data since this was last reviewed.
“Part of the concern around PSA screening is the need to increase MRI capacity. Solutions exist that could do this. For example, we can now do a shorter sequence taking 10 minutes with no need for iv contrast. This removes the need for a doctor in the procedure and is amenable to AI based reporting.
“An alternative possible interim solution is to focus screening programs on high-risk men. It is possible to identify areas with higher rates of late metastatic presentation. These are mostly areas of high deprivation. We also know that black men are at least twice as likely to get prostate cancer as the rest of the population. The third group who would benefit from a targeted approach is men known to carry a gene such as BRC A1 or B RCA 2, which carries both a greater risk of cancer and a greater risk of aggressive disease at presentation. Our group have shown via our Man Van program that we can identify these groups, and they will participate in health check programs if given suitable information packages.
“I very much hope that we can see immediate changes in the approach to prostate cancer diagnosis. The report launching today lays out in detail a pathway to do this.”
Prof Rhian Gabe, Professor of Biostatistics and Clinical Trials Director of Barts Clinical Trials Unit, Wolfson Institute of Population Health (WIPH), Queen Mary University London (QMUL), said:
“The report mentions an assumption of a 72% uptake rate which I would question. Preliminary small scale screening studies have suggested this might be much lower at about 20-25% and so there is a lot of work to be done on how best to invite people, especially those identified as being at risk.
“I agree with the report that investment would be needed for a screening pathway, e.g. radiology, pathology and AI-tools and any new tests that claim to improve upon PSA need evaluation. I agree that it may at first be difficult to identify those with a family history from GP records and so this aspect also needs work.
“The TRANSFORM trial team and collaborators will be working on the gaps in the evidence mentioned above including how to improve uptake and validation of new technologies to help drive the evidence forward for those at high risk and all men between aged 50-75 years.”
Prof Willie Hamilton, Professor of Primary Care Diagnostics (cancer), University of Exeter, said:
“We know there’s a real issue with the current situation, including huge variation in testing men without symptoms, so some clarity and consistency of guidance would be welcome. We need to make progress on prostate cancer, but screening isn’t necessarily the best way forwards. The current screening tests are not very good. We know that Black men have on average higher PSA values than White men, so more will be subject to a ‘positive’ screening test result, yet the raised PSA may not represent life-threatening disease.
“Prostate cancer is present in many men and will do no harm to many of those. So, diagnosis is not always helpful as it can cause unnecessary psychological harm and physical harm, from biopsies. We also need to consider the pressure on the NHS. A 23% increase in PSA tests, MRIs and biopsies is a massive additional workload in a climate where the NHS is struggling to operate.”
Dr Ian Walker, Executive Director of Policy at Cancer Research UK, said:
“The UK National Screening Committee is currently undertaking an independent review into any potential screening programme for prostate cancer which will include an evaluation of the cost effectiveness and crucially, whether it will do more good than harm.
“Prostate cancer is the second biggest cause of cancer death in men, and we know that spotting aggressive forms of the disease early is key to saving more lives. That’s why ongoing research to improve how we detect and treat prostate cancer is so important.”
The report ‘Prostate Cancer Screening: The Impact on the NHS’ was published by Prostate Cancer Research at 00:01 UK time on Tuesday 14 October 2025.
Declared interests
Prof Willie Hamilton: No COI.
Prof Rhian Gabe: I am a co-lead for the TRANSFORM trial.
Prof Nick James: I’m not an author of this report but my research is cited in it.
Dr Matthew Hobbs: CoIs are that I’m employed by Prostate Cancer UK (obviously!) and that Prostate Cancer UK funds a range of research aiming to improve diagnosis of prostate cancer including the TRANSFORM screening trial.
For all other experts, no reply to our request for DOIs was received.