A new analysis commissioned by Prostate Cancer Research suggests that a targeted prostate cancer screening programme for men at higher risk could be introduced across the UK without placing an unmanageable burden on NHS resources. The study, developed with health consultancy CF, examines current diagnostic activity, projected demand, costs and workforce requirements to assess whether targeted screening could operate within existing healthcare capacity.
The findings come as prostate cancer remains the most frequently diagnosed cancer among men in the UK. More than 64,000 men are diagnosed each year, while more than 12,000 die from the disease annually. Around one in eight men is expected to receive a prostate cancer diagnosis during their lifetime, highlighting the scale of the challenge facing the NHS.
The analysis adds to the debate around cancer diagnostics in the UK, particularly the question of whether screening resources should be directed toward groups with a substantially higher risk of developing prostate cancer. The proposed approach would focus on men aged 45 to 69 with a family history of the disease and Black men within the same age range.
Targeted screening could add limited pressure to NHS diagnostic services
Unlike some other major cancers, prostate cancer does not currently have a national screening programme in the UK. Men experiencing symptoms, as well as men over 50 who request testing through their GP, can generally receive a prostate-specific antigen, or PSA, blood test. Patients with elevated PSA levels may then undergo further assessment, including MRI and, where appropriate, a biopsy.
The current system leaves considerable responsibility with individuals to request testing. Prostate Cancer Research argues that this can create gaps in early detection, particularly among groups known to face a higher risk of developing prostate cancer.
To examine whether those gaps could be addressed through targeted screening, CF analysed NHS hospital data and modelled how diagnostic activity would change if eligible high-risk men were systematically invited for testing. The assessment covered PSA testing, MRI scans and biopsies, while also considering the workforce needed to support the additional activity.
The results indicate that a targeted programme could increase demand for these diagnostic services by approximately 23%. Despite that increase, the analysis estimates that the additional workforce requirement would represent between 0.01% and 0.4% of NHS full-time equivalent staff.
The projected financial requirement is similarly limited compared with the overall size of the health service. According to the analysis, implementing the programme would cost around £25 million annually, equivalent to approximately 0.01% of the NHS budget.
These estimates suggest that the principal challenge may not be the overall cost of targeted screening, but how diagnostic capacity is organised and distributed across the NHS. MRI availability, biopsy services and specialist staff would need to be managed carefully to ensure that additional screening does not create delays elsewhere in the diagnostic pathway.
David James, director of patient projects and influencing at Prostate Cancer Research, said the work provided the organisation with a clearer understanding of current diagnostic activity and the potential requirements of expanding screening.
The organisation said the analysis could strengthen the evidence base for policy discussions around earlier detection, particularly for populations with a higher underlying risk.
New diagnostic technologies could help expand screening capacity
The study also considers how developments in diagnostic technology could change the economics and operational requirements of prostate cancer screening over time. Rather than treating current diagnostic pathways as fixed, the analysis examined technologies that could potentially reduce pressure on specialist services as screening expands.
Among the approaches highlighted are reflex blood testing, which could provide additional information following an initial PSA result, and polygenic risk scoring, which uses inherited genetic information to help assess an individual’s likelihood of developing disease.
AI-assisted MRI interpretation and digital pathology were also identified as technologies that could support greater efficiency. These tools could potentially help specialists handle increasing volumes of scans and tissue samples, although their effectiveness, implementation requirements and integration into NHS workflows would need to be assessed before widespread adoption.
The potential role of these technologies is particularly important because MRI and biopsy capacity represents a critical part of the prostate cancer diagnostic pathway. If more men are brought into screening, simply increasing the number of PSA tests would not be sufficient. The health system would also need to ensure that patients with concerning results can move quickly through imaging and, when required, biopsy.
The analysis therefore presents targeted screening as a capacity-management challenge as much as a screening policy question. Its modelling suggests that the additional activity could be accommodated with relatively modest increases in staffing and expenditure, while technological improvements could provide further headroom as demand grows.
For policymakers, the findings also raise an important question about how screening should be targeted. A universal programme would involve substantially larger numbers of men, while a risk-based approach would concentrate resources on groups with a greater probability of developing prostate cancer.
The proposed 45 to 69 age range is intended to capture men during a period when screening could have meaningful value while avoiding unnecessary testing among lower-risk populations. Family history is an established risk factor, while Black men have a higher incidence of prostate cancer than many other population groups.
Prostate Cancer Research said earlier identification could improve outcomes by allowing treatment to begin before the disease reaches a more advanced stage. It could also help reduce inequalities in diagnosis by ensuring that people at elevated risk are proactively offered testing rather than relying solely on individual requests for a PSA test.
The new analysis does not establish that a targeted screening programme should automatically be introduced. Instead, it provides an assessment of whether the NHS could realistically deliver such a programme. Its conclusion is that the financial and workforce requirements appear relatively small in the context of the wider health service.
As prostate cancer cases continue to place pressure on healthcare systems, the findings strengthen the case for examining targeted approaches to earlier diagnosis. For the NHS, the next challenge will be determining whether the evidence is sufficient to move from feasibility modelling toward a structured screening policy, while ensuring that diagnostic capacity, clinical quality and patient follow-up keep pace with demand.
