12-08-2025
Thousands of men given ‘unnecessary' cancer treatment every year due to ‘wild west' guidelines
UP to 5,000 men every could avoid unnecessary cancer treatment if "outdated" guidelines reflected latest evidence, a charity has urged.
Overtreatment can lead to side effects such as erectile dysfunction or incontinence, it warned.
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Prostate cancer is a leading cause of cancer deaths in males in the UK, with around 55,000 new cases diagnosed every year.
However, in some cases, the cancer is slow-growing and unlikely to ever cause the patient harm.
For men whose cancer is unlikely to progress, experts suggest close monitoring is the "best" option.
However, out-of-date guidance from the National Institute of Health and Care Excellence (Nice) on how this is implemented has created a "wild west".
Close monitoring involves blood tests and scans, known as active surveillance.
Nice guidance on active surveillance is designed to advise specialists on how to implement monitoring and which men should be monitored.
However, it hasn't been updated since 2021, according to Prostate Cancer UK.
A Freedom of information (FOI) request analysis by the charity found around one in four (24 per cent) of hospitals rely on Nice guidance alone to implement active surveillance.
It also found 35 hospitals have created their own guidelines, which Prostate Cancer UK warned can lead to inconsistency and confusion among medics.
The charity is now repeating its call for Nice to update its guidance on active surveillance, claiming it could help up to 5,000 men a year avoid overtreatment.
I thought I was drinking too much tea - but it was actually a deadly condition
It also claims the outdated guidance is hindering a screening programme for prostate cancer.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: "To reduce the harm caused by prostate cancer and build the foundations for a screening programme, we need to both save lives and prevent unnecessary treatment but official guidelines still haven't caught up with the clinical evidence.
"Concerns about overtreatment are a major reason the UK does not routinely screen for prostate cancer, despite it being the most common cancer in England.
"Acting on latest research that shows more men can safely opt for monitoring instead of treatment will reduce overtreatment and the harm it causes men.
"We asked Nice to update their active surveillance guidance two years ago, but our request was rejected. Now we have evidence this is potentially affecting thousands of men. Enough is enough."
Current testing for prostate cancer
The NHS uses a prostate-specific antigen (PSA) blood test to check for prostate conditions, including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer, while men over 50 can request a test from their GP even if they do not have symptoms.
But there have been calls to roll the test out across the health service, although some argue widespread use could identify cases which may not have caused problems or needed treatment.
Vincent Gnanapragasam, a professor of urology at the University of Cambridge, said: "Active surveillance is the best treatment option for men whose cancer is unlikely to progress or cause them problems in their lifetime.
"But Nice's outdated guidelines have created a deeply concerning wild west on how surveillance is implemented by different healthcare teams.
What is prostate cancer?
Prostate cancer affects a small, walnut shaped gland that sits underneath the bladder and surrounds the urethra - the tube carrying pee outside the body.
It usually grows bigger as you get older.
The prostate's main job is to help make semen – the fluid that carries sperm.
Most men with early prostate cancer don't have any signs or symptoms - that's why it's important to know about your risk.
Possible symptoms include:
Difficulty starting to urinate or emptying your bladder
A weak flow when you urinate
A feeling that your bladder hasn't emptied properly
Dribbling urine after you finish urinating
Needing to urinate more often than usual, especially at night
A sudden need to urinate – you may sometimes leak urine before you get to the toilet
If you do notice changes in the way you urinate, this is more likely to be a sign of an enlarged prostate, which is very common and non-cancerous.
But it's still a good idea to get it checked out.
In the UK, about one in eight men will be diagnosed with prostate cancer in their lifetime.
Some factors may mean you're more likely to get it.
This includes:
Getting older – it mainly affects men aged 50 or over
Having a family history of prostate cancer
Being Black
If you have any of these risk factors or if you have any symptoms, speak to your GP.
They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer.
Source: Prostate Cancer UK
"This inconsistency is resulting in a lack of confidence from patients in surveillance, who may instead opt to have treatment they may not have ever needed, risking harmful side effects.
"Programmes for active surveillance that are standardised and individualised to a man's risk factors have been tested and proven to work."
The UK's National Screening Committee is currently assessing whether a national screening programme for prostate cancer should be rolled out.
A Nice spokesperson said: "We are committed to ensuring our guidelines continue to reflect the best available evidence and give patients the best possible outcomes.
"They are developed by an independent committee, including NHS clinical experts, and are kept under review to ensure they remain current.
"We are updating our prostate cancer guidelines, including a review of the recommendations around active surveillance, and will be assessing whether our suspected cancer guideline recommendations around age-related thresholds for PSA tests for prostate cancer for onwards referral from primary care require updating."
One in eight men will get prostate cancer
The risk of developing prostate cancer depends on many factors, here are some of the facts about the disease and how many men it affects.
One in eight men will get prostate cancer in their lifetime
It is the fourth most common cancer worldwide, and the most common in men
There are 55,000 new cases every year in the UK, and 1.4million globally
Around 12,000 people lose their lives to prostate cancer annually in the UK and almost 400,000 around the world
Prostate cancer accounts for 28 per cent of all new cancer cases in men in the UK, and 14 per cent of all new cancer cases in men and women combined
Prostate cancer survival has tripled in the last 50 years in the UK
More than three-quarters (78 per cent) of patients survive for 10 or more years
About 490,000 men are living with and after prostate cancer in the UK
It is most common in men aged 75 to 79
Since the early 1990s, cases have increased by 53 per cent in the UK
Mortality rates are up 16 per cent since the early 1970s in the UK
Incidence rates are projected to rise by 15 per cent in the UK between 2023 to 2025 and 2038 to 2040
Mortality rates are expected to fall five per cent in the UK over the same years
