The UK National Screening Committee has decided not to recommend a programme of routine PSA testing for men over 50. This has proved a disappointment to many. We here strongly support evidence-based analysis and have to accept that with the current state of available treatments, the committee’s decision is correct. And here’s the rub, this decision points up the real problem here which is that treatments are simply too invasive and have too many other consequences to justify them for cancers which may not need treatment. From an epidemiological point of view, overall more men will be helped by doing nothing, than are potentially harmed by unnecessary treatment.

And the harms are real, with life-changing consequences for men and their partners which are all too often glossed over as ‘side-effects’. In too many cases the ‘cure’ will be worse than the disease. As many as 50% of diagnosed prostate cancers will not cause early death, but if treated will harm men unnecessarily. Of the other 50%, some will be helped by current treatments, but will still suffer life-changing consequences, and a very small number will have been diagnosed too late, or even present with a cancer so aggressive that no treatment can help.

So if there is an upside from this decision, it must be a renewed emphasis on less-radical treatments than those routinely offered, and research concentration on tracking down the root causes of the disease, designing immunisations to prevent it and treatments that empower the body’s own immune system to defeat it.

However, the committee recognised that particularly vulnerable groups with a genetic disposition should be routinely screened, and there is stronger evidence that may tip the balance towards the same screening for Black men, who are also more vulnerable to the disease.

It should also be noted that any man over 50 has a right to request a PSA test from their GP and certainly this must be more widely advertised to both patients with symptoms and GPs who are often reluctant to comply.