A Growing Concern for Men’s Health
Prostate cancer is the most common cancer in UK men, with over 55,000 new cases diagnosed annually. While advances in diagnosis and treatment have improved survival rates, there is growing concern that outdated NHS guidelines are causing significant harm. Experts warn that up to 5,000 men each year may be receiving unnecessary surgery or radiotherapy for slow-growing cancers that could be safely monitored. The issue lies in guidance from the National Institute for Health and Care Excellence (NICE), which has not been updated since 2021, despite clear evidence that modern diagnostic techniques and active surveillance strategies can reduce overtreatment.
The Impact of Outdated Guidance
The existing approach to prostate cancer detection and management remains rooted in older diagnostic limitations. For men with low-risk cancers, NICE currently recommends active surveillance but sets criteria that many clinicians argue are too restrictive. As a result, some hospitals follow outdated national guidelines while others create their own protocols, leading to a patchwork of care across the NHS. This inconsistency has been described as creating a “Wild West” in prostate cancer management, where patient outcomes can depend more on postcode than on best practice.
The consequences are deeply personal. Surgery and radiotherapy, while life-saving for aggressive cancers, can carry life-altering side effects such as erectile dysfunction and urinary incontinence. For men whose cancer may never have progressed, these risks represent avoidable harm.
Why Change Is Needed Now
Diagnostic tools for prostate cancer have evolved rapidly. Multiparametric MRI scans now allow clinicians to assess the prostate in detail before deciding whether a biopsy is necessary, reducing unnecessary procedures. Advances in transperineal biopsy techniques have further lowered the risk of infection and improved accuracy. These developments mean that more men can be safely monitored without immediate treatment, a shift supported by international evidence.
There is also a wider policy challenge. The UK National Screening Committee is reviewing whether to introduce a national prostate cancer screening programme, but experts warn that current NICE guidelines could undermine its success. Without updated recommendations that reflect today’s diagnostic accuracy, screening could lead to more overdiagnosis and overtreatment, rather than better outcomes.
Addressing Inequality in Diagnosis and Care
Outdated guidance also contributes to inequalities in men’s health. Men in deprived areas are less likely to request PSA tests and more likely to be diagnosed at a later stage. Black men face even greater risks, with research showing they are more likely to present with advanced disease and less likely to receive potentially curative treatment. Updating and standardising guidance would help to ensure that these disparities are addressed as part of a national strategy.
The Path Forward
Prostate Cancer UK and other health advocates are calling for NICE to revise its active surveillance criteria and bring national practice in line with current evidence. This would not only reduce the number of men facing unnecessary treatment but also create a consistent standard of care across all NHS trusts. Coupled with public awareness campaigns and GP engagement, such changes could prepare the ground for a safe and effective national screening programme.
Empowering Patients in the Meantime
Until change happens, men—particularly those over 50 or over 45 in higher-risk groups—are encouraged to have informed discussions with their GP about PSA testing and treatment options. Understanding the benefits and limitations of active surveillance can help patients make choices that protect both their health and quality of life.
The gap between policy and practice in prostate cancer care is no longer acceptable. With thousands of men potentially facing unnecessary treatment each year, updating NHS guidelines is both an urgent health priority and a matter of patient rights. Modern diagnostics have given clinicians the tools to act with greater precision; now, the system must catch up to ensure that prostate cancer care in the UK is not only life-saving but also life-preserving.
