The UK National Screening Committee (UK NSC) makes recommendations to ministers and the NHS across the four nations of the United Kingdom, based on an assessment of high-quality, peer reviewed evidence on whether screening for a certain condition would do more good than harm at reasonable cost. The UK NSC considered the current diagnostic and treatment pathways and consulted on their findings. The evidence package can be found at https://nationalscreening.blog.gov.uk/2025/11/28/uk-nsc-opens-consultation-on-draft-prostate-cancer-screening-recommendation/

Screening is specifically for people without symptoms or a diagnosis. The process must therefore minimise harm, such as unnecessary treatment or anxiety resulting from false positive test results. This level of caution is less relevant for people with diagnosed conditions or already in clinical care. They have sought clinical care or advice for a problem. They are in direct contact with a clinician so they can discuss the merits or otherwise of tests and treatments, rather than simply being provided with generic information to read. They have symptoms or a reason for concern. This means their test is much more likely to represent a true positive result, unlike in screening when people have a greater chance of receiving a false positive result. People in clinical care expect follow-up and face a smaller risk of harm from predictive tests. The ethical position, the ability of an individual to discuss issues with a clinician, and the likelihood of having a condition, all therefore differ significantly between clinical management and screening. Screening can do harm, as well as good (benefit). It is also possible for someone to experience both the harms and benefits of screening at the same time. For example, a man may live longer due to their prostate cancer being identified and treated but also live with serious side effects of treatment.

The aim of prostate cancer screening would be to detect prostate cancer early to prevent death and reduce suffering from the disease. For men with aggressive and/or advanced prostate cancer, early intervention and treatment can allow them to live longer by preventing prostate cancer death. It can also reduce the chances of serious complications such as prostate cancer spreading to other parts of the body. Prostate cancer can spread to the area just outside the prostate (locally advanced or locally invasive cancer), and cause symptoms such as erectile dysfunction, difficulties emptying the bladder and pain. It can also spread further (metastatic cancer), most commonly to the bones and spine, where it can cause severe pain, fractures, or spinal cord compression. Just over one in ten (12% of) men diagnosed with prostate cancer in England have metastatic prostate cancer at the time of their diagnosis. These are important, serious outcomes that screening and treatment would try to prevent.

There have been very large research trials of population screening in England and the United States of America. These studies show that there is a very small reduction in deaths after 15 years from prostate cancer in screened men (two out of one thousand). There are also several harms associated with screening. These arise from the additional tests that men go through to get a prostate cancer diagnosis (including a biopsy of the prostate) and the treatment they may then receive. Harms can arise as early as two weeks after beginning treatment, and can persist for a very long time (six years or more, or possibly a lifetime). For example, after six months:

• For men undergoing prostate surgery:
o 19% (almost one in five) will be unable to control their bladder (moderate to severe urinary incontinence)
o 3% will have moderate to severe impacts on their bowel habits
o 66% (two thirds) will experience moderate or severe erectile dysfunction

• For men undergoing radiotherapy:
o 38% (nearly two in every five) will find it difficult to control their bladder
o 6% will have moderate to severe urinary incontinence
o 5% will have moderate to severe impacts on their bowel habits
o 48% (nearly half) will have moderate or severe erectile dysfunction

The majority of men (c.80%) whose prostate cancers would be identified through screening would not benefit in terms of preventing prostate cancer deaths and metastasis. Many of these men would receive treatment they do not need and the harms of screening would quickly outweigh any benefits at a population level. The challenge is how to identify those men who have aggressive prostate cancer while minimising the risks of serious and long-lasting side effects for many other men. More information on how the benefits and harms of prostate cancer screening were considered within the prostate cancer screening model can be found in the UK NSC evidence papers.

The UK NSC will make a final recommendation soon, after which the Secretary of State for Health and Social Care will consider whether to accept and implement the recommendation.

Department of Health and Social Care