Up to 5,000 men annually could avoid unnecessary prostate cancer treatment if current clinical guidelines were updated to reflect the latest research, according to Prostate Cancer UK.
The charity highlights that outdated recommendations contribute to overtreatment, which can cause debilitating side effects such as erectile dysfunction and urinary incontinence.
Experts increasingly advocate for active surveillance—regular monitoring through blood tests and scans—for men diagnosed with slow-growing prostate cancers unlikely to pose a serious health threat.
However, the National Institute for Health and Care Excellence (NICE) has not updated its guidance on active surveillance since 2021, resulting in inconsistent clinical practices described by experts as a “wild west.”
With approximately 55,000 new prostate cancer cases diagnosed annually in the UK, many men stand to benefit from personalized monitoring strategies rather than immediate intervention.
Prostate Cancer UK’s freedom of information request revealed that 24% of hospitals rely solely on the outdated NICE guidelines for active surveillance, while 35 others have developed their own protocols, leading to variation and confusion among healthcare providers.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, emphasized the urgent need for revision: “To reduce harm and lay the groundwork for a national screening programme, guidelines must keep pace with evolving clinical evidence. Failure to update these recommendations is potentially exposing thousands of men to avoidable side effects.”
Currently, the NHS uses the prostate-specific antigen (PSA) blood test to detect prostate abnormalities, but routine screening is not standard practice. Men over 50 can request a PSA test, and GPs may offer testing if symptoms raise suspicion. Calls to implement widespread PSA screening face resistance due to concerns about identifying cancers that may never require treatment.
Professor Vincent Gnanapragasam of the University of Cambridge echoed these concerns, stating, “Active surveillance is the safest approach for many men, but inconsistent application of outdated guidelines undermines patient confidence and can lead to unnecessary treatments with serious side effects.”
NICE confirmed it is reviewing prostate cancer guidelines, including recommendations on active surveillance and PSA testing thresholds, aiming to align them with current evidence and improve patient outcomes.
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