February 24, 2026

expert reaction to the Prostate Cancer Research report ‘Review of the Economic Model Used to Inform National Decisions on Prostate Cancer Screening in the UK’

Scientists comment on the Prostate Cancer Research report that reviews the economic model used to inform decisions on prostate cancer screening in the UK.

Prof Hashim Ahmed, Professor of Urology, Imperial College London, said:

“It would be incorrect to assume that PSA testing would stop significantly following the introduction of a national screening programme, as is suggested in this Prostate Cancer Research (PCR) report. Equally, the suggestion that older men not covered by a formal screening programme would be denied a PSA test by their GP if they asked for it, raises ethical issues.

“The suggestion in the report around the use of a cheaper short, biparametric MRI, instead of the longer multi-parametric MRI is not yet proven to be effective. The Cancer Research UK funded IP7-PACIFIC is a large 2700 patient randomised trial that is looking at this very question across the NHS and will report next year.

“The request by the report to assume that screen negative men and those who have false positives will not incur further tests and costs is incorrect. Currently, in the NHS, such men are followed up by their GP with repeat PSA tests, often at the request of hospital consultants.

“The York Health Economics Consortium report accepts there are lots of uncertainties in the existing evidence and yet often recommends stitching together various sources of evidence with assumptions on individual elements. Given the degree of uncertainties, and the magnitude of the impact that the National Screening Committee’s decision will have on the UK’s healthcare system, the only legitimate way to address the concerns raised in this report is for everyone to rally round and to deliver on the Prostate Cancer UK and NIHR funded TRANSFORM trial.”

Prof Richard Sullivan, Director of Kings Health Partners, Institute of Cancer Policy, King’s College London (KCL), said:

“The critique from Prostate Cancer Research is based solely on the technical report, with no access to the executable model used by the UK National Screening Committee. This limitation can lead to incomplete or inaccurate assessments, as the critique may not capture all nuances of the model’s functioning. The authors’ interpretations of the model’s assumptions and results may introduce bias, as every model is only as good as the input variables. Without access to the model used by the UK National Screening Committee, it’s difficult to confirm the validity of these interpretations. The critique acknowledges that the scenarios run were “crude” due to time constraints. This suggests that the conclusions drawn from these scenarios may not be robust or reliable.

“The critique’s recommendations may at times generalise findings without adequately considering variations in clinical practice or population differences. While the document cites engagement with clinical experts, the depth and breadth of this engagement could be questioned as this was not a peer reviewed. The critique does not adequately address potential counterarguments or evidence supporting the model’s assumptions, thereby providing a less balanced evaluation.

“While the PCUK’s critique offers valuable insights into the economic model for prostate cancer screening, it also has notable limitations that could affect its overall effectiveness and reliability. While this provides useful additional dialogue, it is, by itself, insufficient to overturn the National Screening Committee’s decision.”

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:

Does the press release accurately reflect the science?

“Yes. It draws on up to date clinical studies that reflect how the NHS currently investigates, diagnoses and treats prostate cancer, so the overall picture is credible and aligned with current best practice. It also highlights an important equity issue: under the current system, black men – who are more likely to develop prostate cancer and to die from it – are effectively disadvantaged by a patient initiated PSA testing model and by the decision not to include them in a formal screening program because of their under representation in research despite their higher risk.

“The report reasonably challenges assumptions used in recent screening decisions. It argues that the national committee may have overestimated the extra cost of a screening pathway and underestimated the benefit, by assuming both that current PSA testing levels will continue unchanged and that uptake of an organised program will be lower than the experience in breast and cervical screening, where most invited women attend and relatively few seek tests outside the national scheme. However, the authors of the PCR report do state that they did not have access to the full data and methods of the NSC report, so their assessment of the methods used by the NSC might not be entirely accurate.”

Is this good quality research? Are the conclusions backed up by solid data?

“Yes. The report is built on a broad and contemporary evidence base, and its main conclusions are consistent with what we see in NHS practice. However, the authors were not given full access to the data and modelling methods used by the national screening committee, which limits the modelling in their own report, and may limit the validity of their conclusions.”

How does this work fit with the existing evidence?

“Over the last decade, changes in how we test and treat prostate cancer in the NHS have reduced many of the harms that were previously seen as major barriers to screening, such as unnecessary biopsies and overtreatment. The report brings together recent advances – including better MRI scanning, more targeted biopsies and more selective use of radical treatment – and argues that these improvements make a well designed screening program more beneficial, and more cost effective, than past evidence suggested.

“For black men, the existing evidence is particularly concerning. They are more likely to get prostate cancer, more likely to present late, and more likely to die from the disease, yet are less likely to be represented in research and less likely to benefit from a system that relies on men coming forward themselves. Excluding black men from a screening offer on the grounds of “insufficient evidence” risks cementing existing unfairness into national policy; the report attempts to correct this by modelling the potential gains of screening in younger black men.

“A limitation of both the NSC report and the PCR report is that both are based on modelling, that is the extrapolation of studies from other or smaller health systems. Real world studies, such as the Transform study, will be important to compare different methods of screening and to assess both clinical and cost effectiveness of each approach.”

Have the authors accounted for confounders? Are there important limitations to be aware of?

“The modelling is broadly careful and grounded in realistic NHS pathways, but it is constrained by the limited access to the national committee’s underlying data and assumptions. Without open access to those models, it is difficult for independent researchers to fully test alternative scenarios or explore key uncertainties, such as different uptake rates or changes in background PSA testing. For a decision of this importance, the scientific models should be open to scrutiny so that clinicians, patients and policymakers can understand and debate the trade‑offs.”

What are the implications in the real world? Is there any overspeculation?

“The main risk of implementing generalised screening for prostate cancer is that we don’t yet know how best to go about it, and studies, such as the Transform trial, that are intended to tell us this, and risk failing if screening is introduced before this evidence is available. Moreover, although cost-effective out patient prostate biopsy is the norm, cheaper MRI scans are not widely in use. Further investment in MRI scanners is needed to cope with the numbers of men who would likely need screening MRI scans, and existing scanners will need to be optimised, and staff trained, to reliably undertake the quicker and cheaper BP-MRIs on which the PCR report is modelled.”

The report: ‘Review of the Economic Model Used to Inform National Decisions on Prostate Cancer Screening in the UK: Final Report’ by Sam Woods et al. was published by Prostate Cancer Research at 00:01 UK time on Tuesday 24 February 2026. 

Declared interests

Prof Hashim Ahmed: HU Ahmed also receives infrastructure support from the NIHR Imperial Biomedical Research Centre and NIHR/CRUK Imperial Experimental Cancer Medicine Centre; the Wellcome Trust, the UK NIHR, the UK Medical Research Council, Cancer Research UK, Prostate Cancer UK, The Urology Foundation, the British Medical Association Foundation, Imperial Health Charity. He was awarded NIHR Senior Investigator status in 2023 He has previously received travel grants and paid proctorships and trial grants from Sonablate; was a paid consultant for Sophiris Biocorp; sponsored conference attendance by Angiodynamics; medical advisory board for Janssen previously in the last 3 years; is a proctor for Rezum treatment and cryotherapy for Boston Scientific and a paid proctor for HIFU by Sonablate. He has received paid speaker honorariums from Varian Medical. He is the Chief Investigator for the IP7-PACIFIC and TRANSFORM trials.

Mr Ben Lamb: Member PCUK Clinical Champion and Clinical Advisory Group. Paid to deliver training to NHS Cancer Alliances, Paid consultancy or honoraria from Astellas, Digital Surgery Ltd, MDoutlook LLC, AstraZeneca, Parsek.

For all other experts, no reply to our request for DOIs was received.