A leading expert committee has advised the UK government against introducing a national screening programme for prostate cancer, concluding that widespread testing is likely to cause more harm than good. Prostate cancer remains the most commonly diagnosed cancer in the country, with over 64,000 men affected annually, yet no routine screening programme currently exists.
Final Recommendations from the UK National Screening Committee
The UK National Screening Committee (UKNSC) released its final guidance, which the government will now consider. The committee determined that mass screening using the prostate-specific antigen (PSA) test does not offer sufficient benefits to outweigh the risks. Potential harms include incontinence and erectile dysfunction in men who undergo unnecessary treatment for cancers that would not have caused symptoms.
However, the committee recommended targeted screening for men with the BRCA2 gene variant who also have a family history of breast, ovarian, pancreatic, or prostate cancers. These individuals face a higher risk of aggressive prostate cancer and should be offered PSA testing every two years between ages 45 and 61.
Exclusion of Other At-Risk Groups
The UKNSC decided against screening for other high-risk groups, such as black men, citing ongoing uncertainty about the balance of benefits and harms. Professor Sir Mike Richards, chair of the UKNSC, emphasised that while screening can reduce prostate cancer deaths to a small extent, it does not improve overall survival. He noted that many men live full lives without the disease causing harm, and current methods cannot reliably distinguish between harmful and harmless cancers.
The decision has disappointed campaigners, including Olympic gold medalist Sir Chris Hoy, former Prime Minister David Cameron, and author Sir Stephen Fry, who have advocated for broader screening.
Focus on High-Risk Genetic Variants
The committee identified men with the BRCA2 variant as the only group where screening clearly does more good than harm. Among those with this variant, between 21 and 35 out of 100 will develop prostate cancer by age 80, often at a younger age and with greater aggression. The recommendation excludes those with the BRCA1 variant due to new data showing a significantly lower risk.
Amy Rylance, director of health services at Prostate Cancer UK, noted that only about 1 in 300 to 400 people carry BRCA gene variations, but the prevalence is higher among Ashkenazi Jewish individuals, affecting up to 1 in 40. The NHS offers free BRCA testing for anyone over 18 with at least one Jewish grandparent.
Implementation and Future Research
The UKNSC estimates that its recommendation will lead to a few thousand men being screened annually. Professor Richards acknowledged the need for better methods to identify eligible patients and invite them for testing, which will be evaluated with the NHS over time. The committee will also collaborate with the Transform trial, launched by Prostate Cancer UK, to gather more data, particularly on black men.
The government will now review the recommendation. The Department of Health and Social Care stated that Health Secretary James Murray will give careful consideration and respond shortly.
Reactions from Experts and Charities
Freddie Hamdy, Professor of Surgery at the University of Oxford, advised any worried man to discuss concerns with their GP. Dr Ian Walker of Cancer Research UK urged the government to accept the UKNSC's guidance, stressing that screening decisions must be evidence-based to avoid unnecessary harm. Conversely, Chiara De Biase of Prostate Cancer UK expressed deep disappointment, noting that without a screening programme, over 12,000 men die from the disease each year.
