Prostate cancer screening: Five things GPs need to know this Movember

As Movember puts men’s health in the spotlight, a major change to prostate cancer screening is raising questions about who should be offered a PSA test and how GPs should assess patients at increased risk.

Following a review of the evidence, the UK National Screening Committee (UK NSC) has recommended introducing targeted screening for men with a confirmed BRCA2 gene variant and a relevant family history of cancer, while stopping short of recommending routine screening for the wider population.

The decision has disappointed prostate cancer charities, which argue that it excludes many men at increased risk, including black men and those with a family history of prostate cancer. They have also questioned whether the evidence underpinning the recommendation adequately reflects advances in diagnostic pathways, including the use of MRI.

The UK NSC, however, concluded that the potential harms of screening outweigh the benefits for the general population and some higher-risk groups, while further evidence is needed to establish the balance of benefits and harms for black men.

With GPs still receiving requests for PSA testing, what does the decision mean for clinical practice? Here are five things you need to know.

1. PSA screening will be introduced for a specific high-risk group

The UK National Screening Committee (UK NSC) has recommended targeted prostate cancer screening for men aged 45–61 who have a confirmed pathogenic BRCA2 gene variant and a family history of breast, ovarian, pancreatic or prostate cancer.

Eligible men will be offered a prostate-specific antigen (PSA) blood test every two years.

The Government accepted the recommendation in June 2026, with rollout in England expected to begin in 2027. The programme will use a call-and-recall system to invite eligible men to be tested.

2. Routine PSA screening is still not recommended

Despite calls for wider screening, the UK NSC concluded that the evidence does not currently support a population-wide prostate cancer screening programme. It also stopped short of recommending targeted screening for Black men, men with a family history alone, or carriers of BRCA1 variants without the qualifying BRCA2 variant.

Although these groups may have an increased risk of prostate cancer, the committee determined that more evidence was needed to establish whether the benefits of systematic screening outweigh the potential harms. This is because the current PSA test is not reliable enough to be offered widely.

For example, PSA testing can produce false-positive results, with around three-quarters of men who have a raised PSA level subsequently found not to have prostate cancer. While some prostate cancers are aggressive and require treatment and screening can help identify these cases, there is currently insufficient evidence to show that making PSA screening more widely available would result in more benefit than harm in the general population.

However, an independent technical review of the UK NSC’s modelling by the York Health Economics Consortium (YHEC) challenged it, arguing that it relied on outdated trial data and did not adequately reflect modern clinical pathways, including MRI-led diagnosis.

The research, commissioned by Prostate Cancer Research and submitted for consideration during the consultation process, also suggested the modelling overstated projected harms and assumed screening only adds costs without accounting for reductions in opportunistic testing.

3. Family history and genetic risk are increasingly important

The decision highlights the importance of recognising inherited cancer risk in primary care. BRCA2 variants are associated with an increased risk of aggressive prostate cancer, while a family history of breast, ovarian, pancreatic or prostate cancer may indicate an inherited cancer predisposition.

A detailed family history should consider cancers affecting both maternal and paternal relatives, the ages at diagnosis and whether multiple family members have been affected.

However, a family history alone does not establish eligibility for the new screening programme. GPs should consider whether patients meet local criteria for referral to clinical genetics, while continuing to assess individual prostate cancer risk in accordance with existing guidance.

The Department of Health has said it is working with Cancer Research UK ‘to see if interim advice can be developed’ to help GPs decide how to respond when asymptomatic men are approached ‘who are concerned about family history’.

4. Men can still request a PSA test – but guidance for GPs has changed

The new recommendation does not replace existing clinical pathways for patients with possible prostate cancer symptoms or asymptomatic men requesting a PSA test. The screening programme is expected to begin rolling out in 2027, and the Government has confirmed that men previously advised to have annual PSA tests will still be able to access them through their GP.

Following the screening decision, the Department of Health and Social Care withdrew the previous Prostate Cancer Risk Management Programme (PCRMP) guidance. GPs are now directed towards the NICE Clinical Knowledge Summaries when discussing the potential risks and benefits of PSA testing with patients.

Patients presenting with lower urinary tract symptoms, visible haematuria or erectile dysfunction should continue to be assessed in accordance with established NICE guidance, including consideration of PSA testing and digital rectal examination where indicated.

For asymptomatic patients requesting a PSA test, shared decision-making remains essential. GPs should explain that a raised PSA level does not necessarily indicate cancer, while a normal result does not completely exclude it. Benign prostate enlargement, infection, recent ejaculation and vigorous exercise can all influence PSA levels.

Individual risk factors, the potential benefits and harms of testing, and the patient’s preferences should inform the clinical decision.

5. The TRANSFORM trial could change future screening recommendations for prostate cancer

In June 2026, the Government announced an additional £18 million to expand the TRANSFORM trial, which is supported by Movember, Prostate Cancer UK and the National Institute for Health and Care Research.

The expansion will help researchers investigate prostate cancer screening among black men, who face a higher risk of developing the disease. The trial is also evaluating whether MRI, PSA testing and genetic risk assessment can improve detection of clinically significant cancers while reducing unnecessary investigations.

The UK NSC has said it will incorporate significant new evidence into its screening model as it becomes available.

Professor Victoria Tzortziou Brown, President of the Royal College of GPs, said: “GPs are committed to improving the early detection of prostate cancer and reducing the number of lives lost to the disease.

“Screening programmes should be introduced where there is clear evidence that the benefits outweigh the potential harms. The NSC’s recommendation reflects the current evidence on PSA-based population screening, including concerns about overdiagnosis and unnecessary treatment, and we note the Government’s decision to accept this.

“At the same time, we recognise the need for continued progress. We welcome ongoing research, including the expansion of the Transform Trial, to develop more accurate approaches to identifying clinically significant prostate cancer. We hope advances in testing and risk assessment will inform future screening policy and improve outcomes for patients.”

Alison Bloomer

Alison Bloomer is Editor of Pavilion Health Today. She has over 25 years of experience writing for medical journals and trade publications. Subjects include healthcare, pharmaceuticals, disability, insurance, stock market and emerging technologies.

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