Prostate cancer is rising rapidly worldwide, and the UK is no exception. It is now the most common cancer in British men, claiming more than 12,000 lives a year. What makes the disease especially dangerous is its silence: early-stage prostate cancer almost always develops without symptoms, meaning many men only discover it once the cancer has already spread. As more cases are diagnosed at later, harder-to-treat stages, concerns are growing over whether enough is being done to catch the disease earlier.Against this backdrop of rising cases and late diagnoses, the debate over early detection has intensified. That debate sharpened recently when the UK National Screening Committee (NSC) rejected proposals for wider prostate cancer screening, triggering strong criticism from Rishi Sunak, Piers Morgan, Sir Chris Hoy and leading cancer charities.Rishi Sunak, a patron of Prostate Cancer Research, has emerged as the most vocal political critic of the NSC’s decision. In a sharply worded column, he described the recommendation as a missed opportunity that could cost lives, arguing that the panel had failed to account for advances in modern diagnostics. Emphasising that prostate cancer is symptomless in its early phases, Sunak said men rely on screening, not symptoms, to catch the disease early.
The push for wider prostate cancer screening
Calls for broader screening have grown louder as new evidence emerges about improved diagnostic tools and rising late-stage diagnoses. Rishi Sunak has been one of the strongest voices pushing for change. He highlighted research showing that modern MRI-first diagnostic pathways can dramatically cut unnecessary biopsies and halve overdiagnosis, addressing one of the NSC’s main objections to screening. Sunak also criticised what he described as an unstructured, inefficient and unfair system, where better-informed or wealthier men can secure PSA tests or go private, while higher-risk groups are frequently overlooked.Broadcaster Piers Morgan backed Sunak’s stance, warning that the UK is missing a major opportunity to save lives, while Chris Hoy, who lost his father to the disease, condemned the decision for failing those most at risk. Charities argue that limiting screening to known BRCA1 or BRCA2 carriers is far too narrow and leaves thousands unaware of their true risk.Although the NSC maintains that evidence remains insufficient for a national screening programme, many experts believe this view is outdated. Leading urologists such as Professor Hashim Ahmed of Imperial College London and Professor Mark Emberton of University College London have demonstrated in multiple clinical studies and real-world trials that combining PSA testing with rapid MRI scans can detect aggressive cancers at earlier, more treatable stages.Their research, including work published through the PROMIS trial and further studies in UCLH and Imperial’s MRI-first diagnostic pathways, shows that MRI reduces unnecessary biopsies, improves diagnostic accuracy and avoids the levels of overdiagnosis associated with older PSA-only screening models.The 42 million pound TRANSFORM trial, launched in 2025 and involving up to 300,000 men, is expected to produce the strongest evidence yet for a modern screening approach. Early findings, due within two years, could reshape national policy and revive the case for earlier, targeted testing.
How prostate cancer could be prevented
While no cancer is fully preventable, research consistently shows that lifestyle, early monitoring, and informed risk assessment can significantly lower the chance of developing aggressive, late-stage prostate cancer.1. Know your risk early, especially if you are Black or have a family historyExperts such as Professor Noel Clarke of Prostate Cancer UK stress that prevention begins with risk awareness. Black men face double the average risk, and men with a father or brother diagnosed before 60 are among the most vulnerable. A major study from the Institute of Cancer Research found that hereditary high-risk men can be up to four times more likely to develop aggressive prostate cancer. Clarke recommends beginning PSA monitoring in the mid-40s for these groups.2. Weight, diet and physical activity matterLarge studies from the World Cancer Research Fund and the Harvard School of Public Health show strong lifestyle links to prostate cancer outcomes. Key insights include the link between higher body fat and more aggressive disease, and the benefit of regular exercise in reducing inflammation and balancing hormones. Diets high in processed or charred meats increase the risk of fatal prostate cancer. The WCRF suggests maintaining a healthy BMI, eating tomatoes and cruciferous vegetables, limiting processed meats and prioritising healthy fats such as olive oil, nuts and oily fish.3. Vitamin D may influence riskResearch from the University of Cambridge and Oxford Population Health indicates that men with severely low vitamin D levels may face higher risk of aggressive disease. Professor Richard Martin notes that maintaining adequate vitamin D plays a meaningful role in reducing inflammatory pathways linked to prostate cancer progression.4. Early PSA testing and MRI for high-risk menProstate cancer specialists like Professor Mark Emberton and Professor Hashim Ahmed argue that early detection remains the most effective preventative tool. Their research at UCL and Imperial College London shows that PSA testing combined with MRI scans can detect aggressive cancers at early, curable stages. This approach reduces unnecessary biopsies by 25 to 40 per cent. Men aged 45 to 50 with elevated PSA or a strong family or genetic risk should undergo early MRI screening. Emberton calls this approach the best chance we have of reducing deaths without mass overdiagnosis.5. Avoid smoking and limit alcoholThe European Prospective Investigation into Cancer study found that smokers have higher prostate cancer mortality. Heavy alcohol consumption has also been linked to more aggressive tumours.6. Consider genetic testing if you have a strong family historyMen with BRCA1 or BRCA2 mutations face significantly elevated risk. Professor Rosalind Eeles, a leading genetic oncologist, advises that men with significant hereditary risk should strongly consider genetic testing, as knowing their genetic status can guide earlier and more effective screening. This is particularly important because the NSC’s current recommendation applies only to known BRCA carriers, leaving thousands of high-risk men outside the screening system.Experts agree on one central truth: waiting for prostate cancer symptoms is waiting too long because early-stage disease rarely produces any. Prevention relies on knowing personal and hereditary risk, early and regular PSA and MRI checks for high-risk groups, healthy weight and diet, adequate vitamin D, exercise, avoiding smoking and considering genetic testing. Combined with improved access to screening, these measures could save thousands of lives. Sunak, clinicians and cancer researchers argue that the UK cannot afford further delay.
