26-07-2025
Testing for prostate cancer around the world. How does the NHS compare?
The global statistics are terrifying. Prostate cancer is the fourth most common cancer in all populations, the second most common cancer among men worldwide, and ranks first in Europe where a third of men who die from cancer will die because of prostate cancer.
It is the most frequently diagnosed cancer in men in 112 countries and the leading cause of cancer death among men in 48 countries. There will be almost three million new cases of prostate cancer a year by 2040, more than double 2022 rates, and the mortality rate will rise by 85 per cent.
Given the figures, it is no surprise that Global Action on Men's Health (GAMH) is calling for worldwide initiative to tackle the threat, lobbying the World Health Organization (WHO) to introduce measures which cover every stage of the prostate cancer pathway, 'from prevention to palliative care'.
Director Peter Baker, warns of a 'tsunami of cases'.
'It will overwhelm healthcare systems. The financial as well as the human costs will be massive. We need to act now to do what we can to prevent it,' he says.
The problem with current testing in the UK
Despite this, up until now, international action has been uncoordinated and piecemeal.
Part of the problem lies in historic testing protocols which rely on PSA (prostate-specific antigen) blood tests, which studies have shown can lower mortality rates through early detection but are also prone to deliver false results, leading to unnecessary biopsies, overdiagnosis and subsequent overtreatment. For this reason, many healthcare bodies in developed nations currently follow the 'informed choice' pathway, in which men can request tests, but are not proactively offered them as part of a national strategy.
In the UK, any man over the age of 50 can ask for a PSA blood test, but these are not actively encouraged as the NHS concedes that 'results can be unreliable'.
And even while tests are available, not everyone is aware of them, which leads to inconsistencies in take up. According to Prostate Cancer Research, in the UK tests tend to be taken up mainly by educated, affluent and health-literate men. The charity also points to inconsistent care and advice offered by GPs.
'Testing is not systematic,' says David James, director of patient projects and influencing at Prostate Cancer Research. 'There's no process involved.'
As with The Telegraph campaign, the charity is calling for the introduction of a system which actively informs men and recommends they get tested at a certain age.
Currently, studies in other nations are looking at how such a system would work.
And the good news is that screening protocols have changed significantly in the past five years, alleviating some of the anxiety and inaccuracy associated with past models.
James explains: 'An elevated PSA score would lead to a trans-rectal biopsy, but as PSA can be elevated for reasons other than prostate cancer, a lot of men ended up going for biopsies who didn't need them, and the biopsy is not a particularly nice process, and it carries a risk of complications, like sepsis.'
The introduction of MRI scans has been a game-changer.
'An MRI now sits in between a PSA test and a biopsy and filters out lots of men who would otherwise have gone on to have a biopsy,' continues James.
Indeed, MRI scans can even determine the clinical significance of a tumour, which means that some men may just need to be monitored on an 'active surveillance' protocol, rather than undergo more radical interventions.
Biopsy protocols have also changed and are now carried out through the perineum (the area of skin between the anus and the scrotum), vastly reducing the risk of infection. Lifestyle and family medical history are also used to inform risk.
These advances are now being used to inform a best-practice model of testing and screening which it is hoped will be adopted internationally in the coming years.
What other countries do
Europe: Experimental screenings
The EU is leading the way in developing screening programmes by funding a project run by the European Association of Urologists called Praise-U. The aim of this is to improve the early detection of prostate cancer across different member nations.
The project is running pilot programmes in Ireland, Lithuania, Poland, and two areas in Spain (Galicia and Manresa). These are designed to test different screening strategies and see what works best.
Lithuania: Invitations to PSA tests between 50-69
Lithuania had a history of systemised prostate testing before the Praise-U project. It has been running active screening since 2006. Under its programme, men aged 50 to 69 and those with a family history of certain cancers get official invitations from the health care system to have a prostate check. It is free, and offered every two years. The system has been refined over time. PSA thresholds and biopsy rates have declined, helping reduce overdiagnosis.
'The programme detects about 2,800 new prostate cancer cases every year, so it is significant,' explains James. 'It's the best example that I'm aware of.'
70 per cent of men aged 50 to 74 participated in the prostate cancer programme at least once in the first 10 years of the screening. That's impressive when you look at the UK figures: Specifically, a study of 212,039 men between the ages of 40 to 69 in the UK found that 62,022 (29 per cent) reported ever having had a PSA test.
Czech Republic: PSA offered between 50-59
Last year the Czech Republic launched a nationwide five-year PSA-based screening programme in which men aged 50-59 are offered a PSA blood test through their GPs. Based on the results of that test, the GP will follow up with either another test in four years, in two years, or an MRI scan and referral to a urologist if necessary.
Sweden: Advanced blood tests
Screening for prostate cancer in Sweden is through informed choice, but the government supports several Organised Prostate Cancer Testing (OPT) trials where all men aged 50 were invited for tests by letter. These programmes use PSA blood tests followed by an MRI where necessary. If an MRI shows suspicious areas, a prostate biopsy is conducted to check for cancer. By the end of 2024, 16 of Sweden's 21 regions had started OPT and collectively invited around 256,000 men, with an average uptake of around 43 per cent.
Since 2022, the Stockholm3 blood test has also been included in national guidelines. It combines PSA, additional protein biomarkers and genetic markers to better predict the risk of aggressive prostate cancer, improving accuracy and reducing unnecessary MRI exams compared to PSA alone.
In the Nineties, Sweden also conducted the Göteborg trial, which was designed to find out whether screening men for prostate cancer using the PSA blood test could reduce the number of deaths from the disease. 20,000 men aged 50–64 took part. Half were invited for PSA testing every two years, half were not screened but could ask for testing if they wanted. The trial found that men who were regularly screened had around a 40 per cent lower chance of dying from the disease than men who weren't.
US: Discussions with healthcare provider
Like the UK, the US runs an elective prostate cancer screening system. In 2018 the US Preventive Services Task Force (USPSTF), a federal expert panel that issues national screening guidelines, ruled that prostate testing should be an individual decision made after shared discussion with a healthcare provider.
The American Urological Association (AUA) and American Cancer Society (ACS) recommends starting discussions at 50, with earlier screening (at 45 or 40) for higher-risk individuals, such as black men, those with family history or genetic mutations, such as BRCA2.
James explains that some health insurers in the US will fund and encourage testing to mitigate future costs.
'They can be more proactive at offering PSA testing and also at offering newer 'reflex' tests, which are additional tests done to further investigate a slightly elevated PSA level, helping to determine if a biopsy or MRI is necessary,' he says.
Australia: PSA incorporated into check-ups
In Australia, there isn't a government-mandated, organised prostate cancer screening programme. However, PSA testing is commonly incorporated into health check-ups, particularly for men over 50 or those with a family history of prostate cancer.
Recent proposals by the Prostate Cancer Foundation of Australia include a 'strong recommendation' for GPs to initiate conversations about PSA testing and to offer testing every two years to all males aged 50–69. The charity also recommends a national public education campaign focused on understanding risk factors and early detection.
