The case for targeted Prostate Cancer Screening in the UK
Prostate Cancer Research commissioned CF to develop an independent, evidence-based analysis of how a targeted screening programme for high-risk men could work in practice. CF analysed current UK testing levels, costs, and workforce capacity through NHS data analysis, secondary research, and clinical insights, then modelled the resource requirements and benefits of implementing targeted screening with existing and also newer diagnostic technologies. The resulting report from Prostate Cancer Research demonstrated that a national prostate cancer screening programme for high-risk groups is not only possible, but practical and affordable—providing a roadmap with quantified costs and workforce demands to make it a reality.
What was the challenge?
There is currently no national screening programme for prostate cancer in the UK; men with symptoms or, under the Prostate Cancer Risk Management Programme, asymptomatic men over 50, can request a prostate specific antigen (PSA) test from their GPs. If elevated PSA levels are detected, onward diagnostic testing takes place in secondary care – usually an MRI scan which, if suspicious, is followed by a biopsy.
However, there are many high-profile cases of prostate cancer progressing undetected until it is too late. Great Britain Olympic gold medallist Sir Chris Hoy and TV presenter David Lammy have both recently spoken publicly about their experiences with prostate cancer, highlighting the critical need for earlier detection, particularly among high-risk groups.
In the absence of a whole population screening programme, it is proposed by many clinicians and various organisations, including Prostate Cancer Research (PCR), that targeted prostate cancer screening aimed at men most at risk – those with family history and/or black ethnicity aged 45-69 – should be introduced.
Prostate Cancer Research (PCR) had previously published a report on the cost effectiveness of a targeted prostate cancer screening programme. However, this research had not determined the capacity of the NHS to implement such a programme. CF were commissioned to establish capacity – in terms of cost, workforce, and demand – that would be required within the NHS to implement a targeted screening programme.
Additionally, various research and policy papers propose alternative or additional testing methods, such as the EpiSwitch PSE test or the Stockholm 3 test, which would have higher specificity and sensitivity. Therefore, PCR also asked us to determine how these newer methods would affect the cost and additional capacity required within the NHS.
What did we do?
What was the impact?
Using the findings from our analysis, PCR produced a report that quantified the activity, cost, and workforce demands of introducing a targeted prostate cancer screening programme.
Together, CF and PCR captured that a targeted screening programme for men aged 45–69 of Black ethnicity and men with a relevant family history will:
- cost the NHS an extra ~£25 million annually (around 0.01% of the NHS budget)
- involve a ~23% increase in the number of PSA tests, MRIs and biopsies delivered
- require an uplift in NHS workforce FTE roles from 0.01%–0.4%
- reduce entrenched inequalities for Black men, those with a family history of prostate cancer and those in areas with high levels of deprivation
In addition, adopting innovations such as reflex blood tests, AI-enabled MRI, polygenic risk scores, digital pathology and other emerging technologies will reduce pressures on services and help pave the way for future whole population screening
Overall, the report evidenced that a targeted screening programme would save lives, reduce inequalities and ease late-stage pressures on the NHS using only a very small proportion of the NHS total budget with minimal overall impact on workforce capacity.
It has also garnered a lot of national attention from the BBC, The Independent, BMJ and many more, with calls to The National Screening Committee to implement targeted screening for prostate cancer in at-risk men.
CF supported our prostate cancer screening project by providing expert NHS data analysis and clinical research. Their thorough, collaborative approach delivered a clear understanding of diagnostic activity and future demands, along with actionable recommendations for implementing targeted screening. CF’s professionalism and clarity were invaluable, giving us confidence to advocate for policy change to expand screening to those at highest risk.
To see the full report, visit Prostate Cancer Research.
