Review and fund improved detection and diagnosis of prostate cancer

Require PSA blood tests to be proactively offered to men at highest risk of prostate cancer. Review emerging evidence from the TRANSFORM trial to inform a future national screening programme for prostate cancer. We believe this will make the health system fairer and reduce inequality.

Black men, men with a family history of prostate cancer, and men from socio-economically deprived areas are disproportionately impacted by prostate cancer. We believe that detecting and diagnosing prostate cancer is now safer and more accurate than ever. Prostate Cancer UK’s research suggests that harms of diagnosing prostate cancer have reduced by 79%. Yet it remains the second biggest cancer killer in men in the UK. We think it is time to review NHS guidelines on the PSA blood test and invest in an early detection programme.

The Department of Health and Social Care is committed to providing the best care possible for men and we are taking the risks and impact of prostate cancer seriously. We are guided by the independent scientific advice of the UK National Screening Committee (UK NSC), and it is only where the offer to screen provides more good than harm that a screening programme is recommended. The UK NSC makes its recommendations based on internationally recognised criteria and a rigorous evidence review and consultation process. It last reviewed the evidence for screening all men for prostate cancer in 2020 and concluded that the UK should not do so.

Whilst it is recognised that the Prostate Specific Antigen (PSA) test can be a valuable diagnostic tool in certain contexts, such as for men who present with symptoms, its limitations mean that it is not currently recommended for population-level screening, i.e. screening men with no symptoms.

This is because elevated PSA levels can be caused by non-cancerous conditions such as benign prostatic hyperplasia (BPH), prostatitis, or recent physical activity. This results in high rates of false-positive results, leading to unnecessary anxiety, invasive biopsies, and potential overtreatment. For example, a diagnosis via a biopsy and treatment (prostatectomy and radiotherapy) carries risks of life-changing harm, such as urinary and faecal incontinence, sexual dysfunction, as well as a smaller but serious risk of sepsis. Additionally, some prostate cancers may not produce elevated PSA levels, leading to false-negative results that provide deceptive reassurance. For these reasons, the UK NSC currently considers that these potential risks outweigh the benefits of population screening.