Yorkshire has the opportunity to help shape the future of prostate cancer screening - Dr Stuart Griffiths

Offering men who know they have a faulty BRCA gene a PSA test - one that measures the level of a protein associated with prostate cancer called ‘prostate-specific antigen’ in the blood - could save lives by finding cancers early or providing regular monitoring so appropriate treatment can be received as early as possible.

However, most people with a faulty BRCA gene are unaware and so this approach does not consider the thousands of men who do not know they are carriers of this genetic change.

And the draft guidance highlights a bigger issue: we still don’t have the evidence to roll out screening for all men, or for other groups of men at high risk such as Black men, those with a family history and those from economically disadvantaged backgrounds.

So there remains a lack of a fair, consistent and systematic route to early detection for men from other high-risk groups.

Prostate cancer is the most common cancer in men in the UK, yet it remains the only major cancer without a national screening programme. For Yorkshire, where health inequalities run deep, this gap is costing lives.

Every year, more than 4,000 men in Yorkshire are diagnosed with prostate cancer. Over a fifth receive that diagnosis at the most advanced stage - far higher than in London.

Why don’t we have a screening programme? The answer lies in evidence, or rather, the lack of it. The PSA blood test, which measures levels of prostate-specific antigen, is far from perfect. It can produce false positives, leading to unnecessary worry and diagnostic tests that can cause side effects. Because it cannot distinguish between fast-growing cancers and slow-growing cancers, many men diagnosed with cancer following a PSA test have also gone on to have treatment for cancers that would never have caused them harm.

It can also produce false negatives, particularly for some rare and aggressive cancers that produce little PSA. Every year, thousands of men have treatment they may not need, while others are diagnosed too late for curative options.

This uncertainty is why the National Screening Committee cannot recommend screening for all men. The evidence simply isn’t strong enough to show that PSA testing saves lives without causing harm. And while combining PSA tests with MRI scans looks promising, we don’t yet have the data to prove it works on a national scale. That’s why research is critical, and why Yorkshire must lead the way.

Yorkshire Cancer Research is funding the IMProVE trial to answer these questions. This study will test whether a screening programme that combines PSA blood tests with MRI scans can detect cancer earlier and reduce unnecessary treatment. Crucially, IMProVE will bring testing into communities via mobile units and diagnostic centres in Sheffield and Leeds, making it easier for men to take that first step.

It will also explore the views of men at high risk, including those from Black or economically disadvantaged backgrounds and those with a family history of prostate cancer, to ensure future screening programmes are designed with equity at their core.

IMProVE will complement the research being conducted through the TRANSFORM trial, which is funded by Prostate Cancer UK, the NHS, the National Institute for Health and Care Research (NIHR) and the UK Government. It will bring screening opportunities to more men in Yorkshire while contributing to the evidence needed for the Government to consider introducing screening for more men at risk of prostate cancer.

Yorkshire Cancer Research is also funding a clinical trial called Finesse, which aims to support the introduction of prostate cancer screening by finding new ways to reduce harm from unnecessary treatment.

Half of men who choose regular monitoring for slow-growing prostate cancer eventually go on to have surgery or radiotherapy due to rising PSA levels, even though the cancer may never cause harm.

One approach to avoiding unnecessary treatment is active surveillance, where men receive regular tests and monitoring so treatment is only given if the cancer progresses.

Finesse is investigating whether an active medication that slows cancer growth can help men remain on active surveillance longer, reducing the need for surgery or radiotherapy. If successful, this could ease concerns about men undergoing treatment they don’t need.

Until we have evidence, any national screening programme could cause more harm than good. But doing nothing is not an option. Men in Yorkshire are significantly more likely to be diagnosed late, and the region’s high levels of deprivation make the challenge even greater. Closing this gap must be a priority, not just for policymakers, but for researchers, charities and communities.

Dr Stuart Griffiths is director of research, policy and impact at Yorkshire Cancer Research.