The UK National Screening Committee is reviewing whether to recommend routine prostate cancer screening for men, and this project will address formal stakeholder criticisms of the economic model underpinning that decision. Why this matters: Prostate cancer is the most common cancer in UK men, but the PSA blood test is controversial. The existing model, submitted by the University of Sheffield in November 2025, found that screening could reduce deaths but would also detect 40–50% of slow-growing cancers that would never cause harm. This overdiagnosis leads to unnecessary treatment, side effects, psychological distress, and added NHS costs. Stakeholders—including clinicians, patient groups, and health economists—have raised concerns about the model’s assumptions, data, and conclusions. If this project succeeds, it will refine the cost-effectiveness calculations that directly inform national screening policy. The revised model could determine whether men aged 45–70 are offered risk-stratified PSA screening, with intervals based on baseline PSA, age, ethnicity, and family history. It may also clarify that screening men with BRCA mutations is cost-effective at £20,000 per QALY, while screening Black men requires stronger evidence. The outcome will shape whether the NHS invests in a screening programme that balances lives saved against harms and costs.
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This project aims to respond to stakeholder comments on the University of Sheffield report Cost-effectiveness of Prostate Cancer Screening for Men of Average and High Risk, submitted to the UK National Screening Committee on 17 November 2025. Stakeholder feedback will be received during the formal consultation period and addressed during and after this period. The published report comprises two phases. Phase 1 involved adaptation and calibration of SCHARR’s microsimulation model to reflect the natural history of prostate cancer. This phase evaluated the cost-effectiveness of one-off prostate-specific antigen (PSA) screening in men at average risk and, separately, in men at high risk, modelled as single-age cohorts. Phase 2 assessed the cost-effectiveness of PSA-based screening in men aged 45–70 years, with screening intervals stratified by individual risk profiles derived from baseline PSA level, age, ethnicity, and family history. The report presents detailed data, methods, and results from the mathematical disease modelling. It concludes that PSA screening in men at average risk and those with familial risk may reduce prostate cancer mortality; however, 40–50% of screen-detected cancers are slow growing and would not have caused harm during a man’s lifetime. As a result, screening may lead to overdiagnosis, unnecessary treatment, treatment-related side effects, psychological distress, and substantial healthcare costs. The findings indicate that screening decisions for men of Black ethnicity require stronger supporting evidence, while screening men with BRCA mutations may be cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year (QALY).
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