Thousands of men with slow-growing prostate cancer are undergoing unnecessary treatment because national guidance is outdated, a leading charity has warned.
A Freedom of Information request by Prostate Cancer UK revealed wide variations in how hospitals manage active surveillance, suggesting that up to 5,000 men each year may be receiving treatment they do not need. The charity is calling on NICE to urgently revise its guidance, last reviewed in 2021.
Prostate Cancer UK highlighted conflicting advice between NICE and NHS guidelines, with 35 hospital trusts creating their own protocols for determining who should receive active surveillance. Analysis of data across England indicates potential overtreatment ranges from 2% to 24%, depending on location.
Currently, NICE recommends active surveillance only for men with the lowest-risk prostate cancer—a group in which nine out of ten show no signs of disease progression within five years. NHS guidance issued last year under the Getting It Right First Time programme extends surveillance to the next lowest-risk category, whose progression-free rate is 80% over five years but requires closer monitoring.
The charity’s research found that 39% of hospitals still treat all men the same, leading some to undergo interventions they may not need, with potentially serious side effects. Updating national guidelines could prevent unnecessary treatment for thousands.
Recent UK research, including a 15-year study reported in 2023, found that active monitoring for localized prostate cancer delivers survival outcomes equivalent to radiotherapy or surgery.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said official guidance has not kept pace with clinical evidence. “Concerns about overtreatment are a major reason the UK does not routinely screen for prostate cancer, despite it being the most common cancer in England,” she said. “Acting on the latest research that shows more men can safely opt for monitoring will reduce unnecessary harm.”
Professor Vincent Gnanapragasam, professor of urology at the University of Cambridge, added: “Active surveillance is the best option for men whose cancer is unlikely to progress or cause problems in their lifetime. But outdated NICE guidelines have created a ‘wild west’ in how surveillance is implemented, undermining patient confidence and leading some to choose treatments they may never have needed, with serious side effects.”
A review last year highlighted that adverse effects from prostate cancer treatment are “substantial and long-lasting.” NICE has confirmed that its guidelines (NG131) will be updated, with a review of active surveillance protocols for localized prostate cancer scheduled for August 2025.
Meanwhile, the UK’s National Screening Committee is evaluating whether a national screening programme for prostate cancer should be introduced.
