With the UK taking its first steps towards introducing a targeted screening programme for prostate cancer, Rebecca Jenkins explains how advances in diagnostics and therapy are reshaping the landscape of prostate cancer care.
Prostate cancer is the most common cancer in the UK and never far from the headlines, with well-known celebrities such as Sirs Chris Hoy and Cliff Richard recently sharing their own stories of a prostate cancer diagnosis and raising awareness of the condition.
More than 64,000 men were diagnosed with prostate cancer in 2022, according to the charity Prostate Cancer UK – an increase of 24% from 2011 when 51,823 were diagnosed, highlighting the impact of increasing awareness of the condition and thanks in part to the so-called Turnbull-Fry effect in 2018.
Amid this background of increased diagnoses and awareness, there has been much debate around how prostate cancer is detected in the UK, with the spotlight firmly on the absence of a national screening programme.
The independent expert-led UK National Screening Committee (NSC) previously concluded that the harms of screening outweighed the benefits due to several factors including high rates of false positive and false negative results from the prostate specific antigen (PSA) blood test.
However, after reviewing an updated evidence model, the NSC’s position changed. In draft recommendations released in November 2025, it stopped short of recommending a national screening programme or targeted screening of black men, or men with a family history, but proposed offering a targeted national prostate cancer screening programme to men with confirmed BRCA1 or BRCA2 gene variants every two years, from age 45 to 61 years.
Transforming prostate cancer screening
The draft proposals were open for public consultation earlier this year, and a final updated recommendation is expected in a matter of weeks after the UK NSC meeting on 26 March.
Alongside those discussions there has been much interest in the launch of a £42 million UK trial, called TRANSFORM, billed as the biggest prostate cancer screening study in 20 years and is co-funded by Prostate Cancer UK with the National Institute for Health and Care Research.
The trial, which in November started enrolling 16,000 men for its first stage, will compare outcomes from the current system, where the onus is men to request a PSA test from their GP, with four of the most promising screening strategies.
The UK NSC has committed to reviewing evidence from the first stage of the trial in two years and incorporating the findings into its modelling.
The four intervention arms will involve various strategies including PSA testing, a newly developed saliva-based polygenic risk test, and scans from a shorter and less resource-intensive form of imaging: biparametric magnetic resonance imaging (MRI).
The current standard of care involves a 30-40-minute multiparametric MRI scan, which has three stages of scanning with the third using gadolinium-based contrast, for which a doctor must be present. However, the two-stage biparametric MRI scan, omits the third scan so it only takes 15-20 minutes and can be performed without a doctor present.
Evidence from the PRIME study
In the landmark PRIME study, published in JAMA in October, researchers from University College London (UCL), University College London Hospital (UCLH) and the University of Birmingham found the biparametric MRI was noninferior to standard care, detecting clinically significant prostate cancer in 29% of men with suspected prostate cancer – the same percentage as with multiparametric MRI.
PRIME study lead investigator Professor Veeru Kasivisvanathan, associate professor of urology and consultant urologist based at UCL and UCLH, says the findings, which he predicts will change clinical guidelines, helped to make the case for including biparametric MRI in TRANSFORM.
‘Biparametric MRI allows more men to get access to the scan because, in principle, you could double your MRI capacity in the best-case scenario,’ Professor Kasivisvanathan explains, noting it would not have been feasible to use multiparametric MRI scans in a screening programme, as there is simply not enough capacity in the system.
The aim of a screening programme is to identify prostate cancer that needs treatment in healthy patients who otherwise would not have had a test, he notes, emphasising that all the intervention arms in TRANSFORM in some way involve MRI in the pathway, which is a new approach.
‘Because of what we’ve seen in a diagnostic setting, we believe that MRI can help identify those who need treatment and avoid the diagnosis of cancer in those who don’t need treatment – and also can lead to targeted treatments, so more specific treatments such as focal therapy, which have lower side effect profiles,’ he adds.
AI assistance in the workforce
While biparametric MRI looks set to make MRI accessible to more men, a challenge remains in having enough radiologists to interpret the images.
At Leeds Teaching Hospitals NHS Trust, clinicians are due to start piloting an artificial intelligence (AI)-powered ‘one-day diagnostics’ service that will use AI to interpret MRI scans for men with suspected prostate cancer, to substantially increase the number of patients having suspected cancer diagnosed or ruled-out within 28-days.
Professor Kasivisvanathan is also preparing to run an international multicentre trial called PARADIGM, which will assess how well AI can find clinically significant prostate cancer on MRI scans compared with expert radiologists.
‘If we can have AI involved in reporting scans or assisting radiologists in some way to ease their workload, this will help us to deliver high quality interpretation wherever you are at the click of a button,’ he explains.
Systemic therapy advancements
Turning from diagnostics to treatment, one of the most striking recent improvements in outcomes for men with prostate cancer in the UK has come from advances in systemic therapies that extend survival and reduce the risk of recurrence, says Natalia Norori, senior data and evidence manager at Prostate Cancer UK.
The STAMPEDE trial showed that for men with high-risk non-metastatic prostate cancer, a two-year course of the hormone therapy abiraterone halves their risk of the cancer coming back after treatment, and halves their risk of dying from the disease.
After leading the call for equitable access to the therapy across the UK, Natalia says Prostate Cancer UK welcomed the decision from the NHS in England to offer abiraterone to men with high-risk localised or locally advanced prostate cancer – a move which is predicted to save 3,000 men’s lives over the next five years.
The recent approval of talazoparib combined with enzalutamide by the National Institute for Health and Care Excellence, offers a new option for men with advanced prostate cancer, showing significant improvements in overall and progression-free survival.
‘These advances reflect a broader shift in practice toward effective systemic therapies that improve survival and quality of life,’ says Natalia.
Innovation and multidisciplinary working
At Barts Cancer Centre, St Bartholomew’s Hospital in London, January 2026 saw a group of patients among the first in the UK to receive an investigational radioligand therapy for advanced prostate cancer that no longer responds to hormone therapy, as part of a phase II clinical trial.
Lutetium (177Lu) rhPSMA-10.1 injection combines a targeting molecule with a radioactive payload to deliver radiation directly to prostate cancer cells while aiming to limit exposure to normal tissues, explains Dr Kenrick Ng, consultant medical oncologist at Barts Cancer Centre and the trial’s principal investigator.
‘The therapy is anticipated to be most relevant in the first or second-line metastatic castration-resistant prostate cancer setting, for patients whose disease has progressed despite hormone-based treatments – an area where there remains a clear unmet clinical need,’ he says.
Prostate cancer care has evolved enormously over recent decades, explains Dr Ng, moving beyond the traditional remit of urology to involve radiation and medical oncologists, as effective systemic therapies mean more patients are living longer, better quality lives with advanced disease.
‘With that progress, however, comes greater complexity, and the need to coordinate care across multiple specialties has never been more important. Radioligand therapy is a good example of this,’ he says, reflecting on the importance of prioritising high-quality multidisciplinary working.
‘Ultimately, beyond protocols and pathways, it is the human factors – trust, communication and strong professional relationships – that make complex treatments possible and ensure patients receive the best care.’
Prostate cancer challenges and opportunities
Momentum for a screening programme is growing, but Natalia cautions that it could be years before a national screening programme is implemented, even for the proposed BRCA cohort.
‘While the evidence base continues to develop, there are immediate steps the Government can take now to improve early detection and save lives,’ she says, pointing to actions including updating guidelines to allow GPs to have proactive conversations with men at highest risk of prostate cancer.
Considering the next few years, Professor Kasivisvanathan predicts that due to advanced diagnostic techniques, including prostate-specific membrane antigen PET-CT scans, together with research into new biomarkers, there is an opportunity ‘better than ever before to identify patients with disease that needs treatment’.
He adds: ‘Couple that with focal treatments, which we’re now well and truly 10 years into, I think patients have a lot to look forward to. They’re not going to necessarily have the radical treatments that they have only been able to be offered in the past. They now have an additional option of these minimally invasive treatment options.’
Prostate cancer as a chronic disease
When it comes to therapeutic treatments, Dr Ng says the challenge is no longer simply about having more drugs available but sequencing them intelligently and selecting the right therapy for the right patient at the right time.
This shift increasingly depends on the appropriate use of biomarkers and close multidisciplinary collaboration, he says, with the goal of prolonging survival while preserving quality of life.
In addition, a wide range of innovative strategies are now entering clinical development, including ways to deliver chemotherapy more selectively to tumour cells through antibody–drug conjugates, to harness the immune system using approaches such as bispecific T-cell engagers, and to expand the scope of radioligand therapy through the use of different radioactive emitters.
For Dr Ng, a personal ambition is to see prostate cancer increasingly managed as a chronic disease.
He concludes: ‘The challenge ahead is to translate this scientific momentum into longer, better-quality lives for our patients – but the reasons for optimism have never been stronger.’