Prostate Cancer Screening

Peter Prinsley Excerpts

Monday 26th October 2026 Westminster Hall

[Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Thank you for chairing this debate, Dr Murrison. I declare an interest in that I am a surgeon and appointed chair of the all-party parliamentary group on prostate cancer.

Prostate cancer bewilders people. They think, “Surely it must be like other cancers we know about? Find it early, treat it early and save lives.” Only lung cancer causes more death in men, but prostate cancer is not so simple. We know it to be a range of diseases that behave quite differently. At the one end is the dreadful spreading disease of cancer that kills men, sometimes quickly and sometimes very young, and at the other end are the indolent cancers that simply sit around causing little trouble, so that the patient lives with the cancer and dies of something unrelated. The great dilemma is how to distinguish which is which. If we identify cancers that are, in fact, not going to cause any trouble and we treat them, we will need to deal with the consequences of the treatments and side effects that so many men fear—incontinence and impotence—and we risk doing more harm than good. That, in simple terms, explains why the screening experts have determined that at present whole-population screening is not the way to go. People find that a little difficult to understand, and so do I, to be honest.

As we have heard, at least two former prime Ministers have been advocating for screening, as have a number of famous sportsmen. The blood test used in screening is the PSA test. What is the problem? False positives—three quarters of men with PSA greater than 4 ng/ml will on biopsy be found not to have cancer—and false negatives, as men with cancer can have normal PSA. So it is not a yes or no test, and is perhaps not massively useful. The UK National Screening Committee says we should do targeted screening of men with the BRCA2 gene and a family history of prostate cancer, but it might be best to use MRI for those men.

I would like to say that there is hope. Analysis of surgical samples of prostate cancer subjected to genetic study at the University of East Anglia, where I too lately completed an MD in medical genetics studies, will soon allow us to distinguish between bad prostate cancer and good prostate cancer. We can be proud of how British science is contributing. I urge our Government to use this Parliament to support that research and those amazing scientists in their bold endeavour.

--- Later in debate ---

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Thank you for your chairmanship today, Dr Murrison.

In passing, I thank the Government for changing their mind about the Health Services Safety Investigation Body and for keeping that body, so that it can continue working as it is. I wonder what it would make of a systemic study of the safety management risks and how they are being managed with prostate cancer and screening, because I see very different experiences across different European countries and a wide variety of methods of gathering data. Blanket screening exists in very few countries.

I heard what the hon. Member for Bury St Edmunds and Stowmarket (Dr Prinsley) said, but my understanding is that an MRI scan followed by a needle biopsy need not necessarily have much in the way of adverse health effects. I had three MRI scans, but no needle biopsy.

[Dr Prinsley]

The problem is that that is not the screening test—the screening test is the PSA, which, as we have said, is unreliable.

[Sir Bernard Jenkin]

Many tests for initial diagnosis of many conditions are unreliable. The problem is that the Government are telling people, “You cannot have a PSA test”, unless, of course, they buy a testing kit from some fly-by-night internet company. There is a lot of that going on, which is clogging up the health system.

If someone has a doubt about what is happening down there, it should be possible—indeed, it should be encouraged by GPs—for them to have a PSA test as a precaution. If the result is a false positive, let us find out that it is a false positive. That is a much cheaper option. I mean, look at the number of deaths. Each year, 64,000 men are diagnosed with prostate cancer and there are 12,000 deaths from it. This is a very serious health situation and we should not be tolerating it.

What I see in the system is an excess of caution. Okay, we now have this Transform trial, but its effect will be to put off any further decisions until 2027. Why are we doing that? There is plenty of data and plenty of experience for the Government to make more flexible decisions.

One always wonders whether the committees that make these decisions are really independent or whether they are under pressure to control costs, because, of course, if there are more PSA tests, there is a need for more people to scan and to biopsy, and there will be more false positives to deal with, and all of that has a cost. Cost alone should not be the metric; that is not how safety is run in other industries.

There needs to be information, and a balanced and independent diagnosis of whether the system is generating the right data. Based on the evidence we already have, we are not testing enough people and we are not doing enough MRI scans. We should be doing much more.