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experts comment on the draft recommendation (targeted screening programme should be pursued for men with a confirmed BRCA1 and BRCA2 variant every 2 years, from age 45 to age 61) for prostate cancer screening from the national screening committee
Rhian Gabe, Professor of Biostatistics and Clinical Trials, Queen Mary University of London and Co-lead of the TRANSFORM trial said:
“The recommendation to screen men with BRCA1/2 variant for prostate cancer is to be applauded. It now becomes more important than ever to provide evidence to inform policy regarding whole population screening in men and higher risk groups including Black men and those with a family history. The TRANSFORM trial which is underway is aimed at providing evidence on the best way to screen for prostate cancer and the trial team stand ready to work with the NSC and key stakeholders.”
Professor Ros Eeles, Professor of Oncogenetics at The Institute of Cancer Research, London, said:
“1 in 300 people in the population have an alteration in one of the BRCA genes.
“Men with the BRCA1 gene fault are more than three times as likely, compared with non-carriers, to have aggressive prostate cancers that are likely to grow and spread quickly. Risk of developing cancer was almost double, but this wasn’t statistically significant.
The age at which they would develop cancer is the same as the general population.
The risk of prostate cancer in BRCA2 carriers is more than doubled, as is the risk of aggressive prostate cancer, and they will develop prostate cancer at a younger age, on average.
“If you stop screening at 61 years of age, you miss nearly half of all cancers for BRCA carriers between 40-69 years:
Of the cancers we found in the IMPACT trial, 49% of them in BRCA1 were between 61-69, and in BRCA2 42% were in that age group.
“We’re very pleased to see that the National Screening Committee has recommended that PSA testing for men who carry BRCA1 and BRCA2 mutations is introduced. This recommendation is based on research led by my team at The Institute of Cancer Research, which showed that these men face a significantly higher risk of developing prostate cancer and are more likely to experience aggressive forms of the disease. PSA testing picks up cancers at an earlier stage, when they are easier to treat – which will ultimately save lives.
“However, the 5-year data from our IMPACT screening trial show that cancers are picked up each year that these men are tested in BRCA2 carriers, and in all but one of the 5 years in BRCA1 carriers. We therefore recommend annual screening, rather than every two years – to avoid the risk that an aggressive cancer could be allowed to grow unchecked for a whole year.
“The NSC has recommended that BRCA carriers be tested from the age of 45 to 61. Our research offered screening for cancers at a younger age, and we have been urging regulatory bodies to act on the evidence, offering all men with a BRCA1 or BRCA2 mutation from the age of 40 – up until the age of 69 – annual PSA testing. This has been the recommendation in Europe to date for BRCA2 carriers.
“Today’s recommendation is indeed a vital step toward reducing deaths from prostate cancer. However, unless BRCA testing is expanded, there are thousands of men who will miss out on this screening programme. The NHS needs to offer BRCA testing to more men, starting by offering testing to male relatives of BRCA carriers.
“We know that Black men are also at a higher risk of developing prostate cancer. At the moment, the PSA test is not a good enough marker of increased risk of disease in this group of men. This is why we at the ICR are leading the PROFILE trial, to look for new markers that we hope will be better at detecting prostate cancer. We are also co-leading the TRANSFORM trial, which will compare different methods of detecting prostate cancer using MRI and genetics – and which aims to recruit more Black men than any previous trials, in order to build this evidence base. We’re looking forward to feeding into the consultation process in the coming months.”
Mr Ben Lamb, Consultant Urological and Robotic Surgeon, Barts Health and UCLH NHS Trusts, and Clinical Senior Lecturer, Barts Cancer Institute, Queen Mary University of London (QMUL), said:
“This result is a double-whammy for black men: not only are they at 2-3x higher risk of prostate cancer diagnosis, and higher risk of death, but they are also underrepresented in research into prostate cancer screening, which means that the data needed to support the case for screening in black men is not robust enough for the screening committee to rely on. Its hard to accept a decision that claims to be evidence based, when we know that the evidence does not fully represent the interests of black men.
“Screening of men with BRCA genes is good news, but these are a small minority of men diagnosed with prostate cancer, plus the majority of men do not know whether or not they carry BRCA genes. This decision may drive a surge in BRCA testing from the educated, worried and affluent well which will not help those men most in need.
“Family history is complex- the screening committee point out that around 1/3 men have a family history of prostate, breast or ovarian cancer, but this is not surprising given how common prostate and breast cancers are. Data on family history available to GP’s is often poor and work needs to be done to improve the capture and coding of this in patients’ medical records in order for it to be a useful resource in counselling men concerned about their risk of cancer.
“The current system in which testing for prostate cancer is driven by factors such as geography, health literacy, health anxiety and affluence is unequitable, ineffective and poor value for money. Maintaining status quo risks entrenching the disadvantages faced by black men and those in more deprived groups and regions. A political decision with more investment in research and health equity is now needed to start to address this inequality.”
Prof Colin Cooper, Professor of Cancer Genetics, Norwich Medical School said:
“This is not surprising as the committee only usually considered death as an endpoint and there have been no new data since the last reporting (I believe in 2021). I understand that a lot of men will find this frustrating as we all know that it’s important to detect aggressive prostate cancer early. However, the problem is that most of the prostate cancers detected by screening are harmless, and we do not have reliable ways of distinguishing aggressive from non-aggressive disease. This is why the work at UEA is so important. We have 2 tests that can identify aggressive disease that need treating. The PUR test is a urine test; if you are PUR-4 you have a 50% chance of dying from prostate cancer. The Tiger/DESNT test is a test carried out on prostate tissue following diagnosis. If you have a Tiger Cancer, you have an 80% chance of developing metastatic life-threatening disease. Both Tiger cancer and PUR_4 cancers would need immediate treatment. We are currently developing these tests so they can be used routinely by men in the UK population.”
Dr Alastair Lamb, Senior Clinical Lecturer, Barts Cancer Institute, St Bartholomew’s Hospital, said:
“This recommendation is fascinating. Firstly, because it’s not a blanket “no”. The NSC has recommended screening for the approximately 21,000 in the UK between age of 45 and 61yrs who have an inherited BRCA mutation. Second, because they did say “no” to everything else. Of the four options considered in the excellent Sheffield cost-effectiveness study – general population, familial risk, black ethnicity, BRCA mutations – BRCA status was the only option they could recommend with any certainty. The problem, of course, is that our current tests (PSA and MRI) would turn too many healthy men into worried patients, while only benefitting a very small number. This is the big question, and it’s about philosophy really, rather than medicine. If you had an unlimited supply of healthy uncles, how many of them would you be happy to harm to make a difference to one? Twenty? Ten? Five? At the moment, at best we would have to screen 200 men to benefit one. And after diagnosis, we currently have to treat at least 10 men to benefit one. The other men are put through worry, painful and time-consuming tests, and potentially harmful treatments for no gain (so-called overdiagnosis and over treatment). This has to change! Thankfully, money is now being invested by the government and charities into research to make sure of this change. Prostate Cancer UK’s TRANSFORM Trial is hugely exciting as it should provide answers as to how and who to screen. And scientific research funded by Cancer Research UK into the development of lethal prostate cancer should provide answer on who to treat. It may take some time but big changes are coming!”
Simon Grievson, Assistant Director of Research at Prostate Cancer UK, said:
“While it’s extremely disappointing to hear that the evidence doesn’t yet support comprehensive screening for prostate cancer, the story doesn’t end here. The National Screening Committee’s review suggests that screening is still likely to cause too much harm through overdiagnosis of slow growing cancers that may not go on to cause any harm. Prostate Cancer UK will continue to work tirelessly to provide the robust evidence needed to show the best way to screen men to save more lives while reducing these harms, and our £42million TRANSFORM trial, launched last week, is designed to do just that. Early results from the trial could provide the evidence needed to tip the balance in favour of screening in as little as two years.
“The NSC particularly highlighted the lack of evidence for screening in Black men, who are twice as likely to get prostate cancer, yet have historically been underrepresented in research. TRANSFORM aims to tackle this by ensuring that at least 1 in 10 men invited to the trial are Black, and by working with Black community groups to ensure that future evidence is informed by, and reliable for, the men who stand to greatly benefit from screening. While today’s news is certainly welcome for men with BRCA gene variants, who are at very high risk, they represent a relatively small proportion of men affected by prostate cancer. We can’t afford to keep leaving prostate cancer diagnosis to chance, which is why it’s vital that we deliver the science to show definitively that screening can safely and effectively be delivered for all men at risk of the disease.”
Laura Kerby, CEO of Prostate Cancer UK, said:
“The committee’s decision will come as a blow to the tens of thousands of men, loved ones and families who’ve fought for a screening programme. Today we’re deeply disappointed, but as determined as ever, and it won’t slow us down. People are sick and tired of seeing the men they love harmed by this disease, and we won’t rest until no man’s diagnosis is left to chance.
“We know that a mass screening programme could save thousands of men’s lives. While screening men with BRCA gene variations will save only a fraction of that, the committee’s decision is the first time they’ve recommended screening of any kind for prostate cancer. It shows that research and evidence can shift the dial and save men’s lives. And the research programme that could achieve screening for all men is already underway – our £42 million TRANSFORM trial which will bring new evidence back to the screening committee in just two years. If everyone who’s upset with today’s decision joins with us to fund the future of screening, we can get the evidence we need to change it.”
Professor Hashim Ahmed, Chief Investigator of the Prostate Cancer UK/ NIHR-funded TRANSFORM trial, Chair of Urology at Imperial College Healthcare NHS Trust and Professor of Urology at Imperial College London said:
“The National Screening Committee’s draft recommendations show that large scale trials such as TRANSFORM are crucial. They provide the critical evidence needed to determine whether a national screening programme for prostate cancer should be delivered in the UK.
“By testing new ways to diagnose the disease and studying the tests we currently use, TRANSFORM will reveal the best way to screen men for prostate cancer, so the disease is diagnosed earlier, minimising harms and ultimately saving more lives. We strongly encourage anyone who is invited to take part to get involved and help shape the future of prostate cancer screening.”
Dr Ian Walker, executive director of policy at Cancer Research UK, said:
“It’s good news that prostate cancer screening is being considered for men with faulty BRCA genes, which increase a man’s risk of developing an aggressive type of the disease. The UK National Screening Committee’s analysis shows that screening this group will save lives. We support the committee’s conclusion that for other groups of men, there isn’t currently enough high-quality evidence that screening would do more good than harm – it can miss dangerous cancers and detect ones that don’t need treatment.
“Work is still needed to understand how the proposed screening programme could be delivered, and we look forward to the UKNSC setting out further details in due course. Cancer Research UK will continue to look for new and better ways to improve detection of the disease – including funding clinical trials into prostate cancer so we can continue to save more lives.”
The draft recommendation written by the National Screening Committee was released from embargo at 15:00 on Friday the 28th of November 2025.
Declared interests:
Rhian Gabe: I am a co-lead on the TRANSFORM
Professor Ros Eeles: co-lead of TRANSFORM, led the IMPACT trial, and does private practise genetic testing
Mr Ben Lamb: Member PCUK Clinical Champion and CAG, Member BAUS section of Oncology executive committee, Paid to deliver training to NHS Cancer Alliances, Paid consultancy or honoraria from Astellas, Digital Surgery Ltd, MDoutlook LLC, AstraZeneca, Parsek
Prof Colin Cooper: I hold a granted patent for the Tiger Test and have a submitted patent for the PUR test.
Dr Alastair Lamb: Alastair Lamb’s lab is funded to improve prostate cancer risk stratification. Emphasising current uncertainty may improve their chances of obtaining further funding. His private practice centres on treating men with prostate cancer. He acknowledges that any talk or article he gives/writes, may increase his visibility to potential future patients.
Simon Grievson: No conflicts of interest
Laura Kerby: No conflicts of interest
Professor Hashim Ahmed: Ahmed receives core funding from the UK NIHR Imperial BRC and Imperial NIHR/Cancer Research UK Experimental Cancer Medicine Centre (ECMC); receives research funding from the Wellcome Trust, UK Medical Research Council, Cancer Research UK, Prostate Cancer UK, UK NIHR, The Urology Foundation and Imperial Health Charity for trials in prostate cancer; is a paid proctor for HIFU (Sonablate Corp), cryotherapy (Boston Scientific), Nanoknife (Angiodynamics) and Rezūm (Boston Scientific); is a paid scientific advisory board member for Francis Medical; has given lectures for Boston Scientific, Ipsen, Astra Zeneca and Janssen; has received funding to attend scientific conferences from Janssen, Angiodynamics and Sonablate Corp; and has previously been on the medical advisory board for Janssen, BUPA Insurer and AXA PP Insurance but not currently. He conducts private medical work in urology (particularly diagnosis and treatment of prostate cancer and benign prostate diseases) in BUPA Cromwell Hospital and Nuffield Parkside Hospital.
Dr Ian Walker: no conflicts of interest to declare
For all other experts, no reply to our request for DOIs was received.