The NHS is overtreating thousands of men for prostate cancer, with around 5,000 patients a year undergoing unnecessary radical treatment for cancers that are unlikely to cause them harm, a leading charity has warned.
While many prostate cancer cases require intervention, the cancer in one in four men is so slow-growing that they should be offered regular monitoring—known as active surveillance—instead. This approach avoids the life-changing side effects of surgery and radiotherapy, such as incontinence and erectile dysfunction.
Currently, around 6,500 men opt for active surveillance each year out of 56,000 men diagnosed in the UK annually. However, a new report from Prostate Cancer UK shows that another 5,000 could benefit. The charity says outdated official guidelines are largely to blame. The National Institute for Health and Care Excellence (NICE), which produces them, has said it is in the process of updating its recommendations.
Outdated Guidelines
NICE currently recommends that active surveillance, involving regular blood tests and scans, should be offered to the lowest-risk patients. For this group, nine out of ten men show no signs of their cancer spreading within five years. However, newer studies have found that this could be safely expanded to include the next-lowest risk group, in which eight in ten men show no signs of the cancer spreading over the same period.
Evidence gathered by Prostate Cancer UK shows that while many hospitals have already started offering active surveillance to this larger group, a quarter have not. Analysis of data in England reveals this has led to overtreatment rates varying between 2% and 24% across different hospitals. The charity claims this discrepancy results in around 5,000 men a year receiving medical treatment they may not need.
Some of this is due to patient choice, as some men prefer radical treatment even when monitoring is an option. However, the charity argues that more consistent NHS guidance would bolster the case for a national prostate cancer screening programme, a debate that has gained traction since the diagnosis of Olympic cyclist Sir Chris Hoy. One of the main barriers to a screening programme is that the current blood test (PSA) can be unreliable and lead to unnecessary, life-altering treatment.
"Delaying Treatment Was Invaluable" đź’¬
"We need to both save lives and avoid unnecessary treatment to reduce the harm caused by prostate cancer and lay the foundations for a screening programme," said Amy Rylance of Prostate Cancer UK. "NICE must update its guidelines to reflect the latest evidence."
Michael Lewis, 63, from the West Midlands, was one of the patients who opted for monitoring. He was diagnosed with low-risk prostate cancer in 2020 and chose active surveillance. His cancer later proved to be more aggressive, and he had his prostate removed four years later. He said delaying the treatment was invaluable.
“I was able to continue my daily life without having side effects,” he said.
A spokesperson for NICE said it was reviewing its prostate cancer recommendations with the aim of updating them. "We are committed to ensuring that our guidelines continue to reflect the best available evidence and that they ensure patients get the best possible outcomes," they said.
