The decision by the UK National Screening Committee (UKNSC) not to implement a widespread prostate cancer screening program has drawn significant criticism, with opponents pointing to the committee's composition as a major concern. Despite prostate cancer being the most common cancer in the UK, the committee's recommendation, released in May, would only qualify men aged 45 to 61 with a rare gene mutation and a family history of certain cancers for screening, potentially affecting as few as 1,500 individuals.
Prostate cancer campaigners have labelled the decision a "profound disappointment" and "a real step back," warning of avoidable deaths. A key point of contention is the absence of urologists, the specialists who diagnose and treat prostate cancer, from the 13-member committee.
Chris Booth, a retired consultant urologist and founder of men's health charity Chaps, described the decision as "incomprehensible" and "laughable," stating that the lack of real-world expertise relies on "discredited, deeply flawed" research. He argues that PSA testing, combined with modern MRI scans, is a "cheap and effective" method for identifying men who require further investigation.
The UKNSC operates on principles that include a reliable test, effective treatment, and ensuring screening provides "more benefit than harm at a reasonable cost." The committee has stated that PSA blood tests can be unreliable and that many prostate cancers grow too slowly to cause problems, meaning treatment could lead to unnecessary risks of impotence and incontinence, thus doing more harm than good.
However, Professor Anne Mackie, UKNSC director of programmes, has previously emphasized the potential harms of screening, noting that "all screening does some form of harm" and "early detection is not always a good thing." Other committee members, such as clinical genetics consultant Anneke Lucassen and professor of public health Chris Hyde, have echoed the sentiment that "prudence, not popularity" guides their decisions and that screening must do more good than harm.
This cautious approach stands in contrast to health authorities in Europe, where wider screening is being advanced under the guidance of the European Association of Urology. Prostate cancer charities argue that the UK is losing more than 12,000 men annually to the disease, with only half of cases caught at a curable stage.
The British Association of Urological Surgeons acknowledged the committee's recommendations as a "pragmatic and evidence-based approach" for higher-risk groups but noted the final recommendation applies to a "relatively small proportion of men at increased risk" and presents "significant practical challenges" in identification.
David James of Prostate Cancer Research criticized the UKNSC as "static and backwards-looking," asserting that the evidence used to reject screening predates modern advancements like MRI, improved biopsy techniques, and active surveillance. Martin Davies, chairman of the Prostate Project charity, called the committee's concerns about over-diagnosis and over-treatment based on "out-of-date information."
Concerns have also been raised about the lack of diversity, particularly regarding black men, who have double the risk of developing prostate cancer. Professor Frank Chinegwundundoh highlighted the "grave mistake" of not adequately considering black men and those with a family history, calling it "clinical negligence." He noted the absence of any black members on the committee, a point echoed by director Sir Steve McQueen, whose father died of prostate cancer, who branded the committee "indefensible" for this oversight.
The UKNSC maintains that widespread screening is not permanently ruled out and that its position may evolve with new evidence. However, campaigners express concern that given the committee's cautious track record, any potential change of stance could be a lengthy process, citing the nearly decade-long delay in recommending targeted lung cancer screening after its approval in the US.