NHS recommendations on prostate cancer screening are valid

The NHS draft recommendation against routine prostate cancer screening stems from the conclusion that the harms would outweigh the benefits. Guidance continues to recommend against prostate cancer screening for men of any age, including those at higher risk, except for men with known BRCA1 or BRCA2 genetic mutations—a still untested strategy.How did the National Screening Committee (NSC) reach these recommendations? First, prostate specific antigen screening cannot preferentially identify those with clinically relevant prostate cancer, leading many healthy, asymptomatic men into unnecessary laboratory testing, imaging, and prostate biopsy. Magnetic resonance imaging (MRI) as a triage test may reduce both biopsies and unnecessary detection of low grade cancers but increases costs and complexity.1Second, prostate cancer is heterogeneous. Although the more aggressive phenotypes often metastasise and result in death, a large proportion of prostate cancers are grade group 1, which have little to no potential to progress or metastasise. These are unlikely to…