Men would come forward for prostate cancer screening
How can we overcome the reluctance of men to come forward for the care they need, including, for example, visiting their GP?
This is a key question that the government hopes to answer in its forthcoming men’s health strategy. But for one area of care at least, the NHS would be pushing at an open door.
Our new research shows the majority of men would come forward for testing if invited as part of any future national prostate screening programme.
We’re now urging policymakers to consider men’s views, alongside clinical and economic evidence, when reaching a decision on whether (and how) to introduce a national screening programme.
One in eight men affected
Improving cancer outcomes is a key aim of the first ever national men’s health strategy, and a new national cancer plan, both due out by the end of the year.
Launching its public call for evidence on the strategy, the Department of Health and Social Care (DHSC) noted that prostate cancer, a male-only disease, was now the most common cancer diagnosed in England.
Overall, one in eight men will develop prostate cancer, usually after the age of 50. For Black men this risk doubles to one in four and from an earlier age. Overall, the number of men dying from prostate cancer totals more than 10,000 men every year.
Behind stark statistics lie human stories. Team GB Olympian Chris Hoy last year disclosed he’d received a terminal diagnosis of prostate cancer in his late 40s, after first seeking help for shoulder pain. He’d had no symptoms of prostate problems, and the pain was caused by a secondary tumour from the spreading cancer.
The current NHS approach
There is no national prostate screening programme to routinely invite men for testing, like there is for bowel, breast and other major cancers. Wes Streeting, the Health and Social Care Secretary, said in April he backed the principle of a national screening programme, but would be ‘guided by the evidence’ from experts.
DHSC didn’t ask men for their views on screening in their call for evidence on men’s health strategy, so we sought to plug this evidence gap. Our poll, of more than 3,500 men aged 18+ in England, is believed to be the first to ask men if they would take part in any future programme.
Would men attend screening?
Contrary to evidence that men are reluctant to attend other services across the health and care system, our findings show:
High likelihood of men attending screening
- 79% of all men said they would be likely to attend an appointment when invited, if the NHS introduced prostate screening routinely.
- This rises to 81% for Black men – an important finding for health inequalities, given their increased risk.
Likelihood increases with age
- 89% of men aged 65-74 in our poll said they’d be likely to attend.
- This decreased to 65% of men aged 18-24.
People on low incomes less likely to attend
- 67% of people who said they were financially ‘really struggling’ said they would attend if invited.
- Likelihood increased to 89% for respondents who were ‘very comfortable’ financially.
Reasons for reluctance
In our poll, 7% of men said they would be unlikely to take part in any future screening programme, and we asked them to select reasons why. We found:
- 25% of this group of men generally don’t like medical appointments
- 22% would prefer to wait until they had any symptoms
- 21% don’t think they’re at risk of prostate cancer.
The second figure here in particular shows a need for greater awareness, as prostate cancer is often asymptomatic until later stages.
Why all men aren’t routinely tested
There has been no national screening programme for prostate cancer because the initial diagnostic tool – the Prostate-specific antigen (PSA) blood test - is regarded as clinically unreliable. It sometimes shows ‘false positives’ and puts men through unnecessary anxiety and biopsies. It can also lead to detection of early and slow growing cancers - the treatment for which can cause side effects such as incontinence or erectile dysfunction, which are often more harmful than leaving the cancer alone.
However, campaigners told an MPs’ inquiry last year that a targeted national screening programme, perhaps with more advanced technology, was necessary. They argued it would stop the NHS missing cancer in men most at risk, but who find it a topic they’re too uncomfortable to raise with doctors – or simply can’t get help for due to access barriers.
The government is now waiting for the UK National Screening Committee to decide on six options for a targeted national screening programme, such as screening Black men aged 45-70 or screening all men with a close relative who’s had prostate, breast or ovarian cancer.
How GPs respond to men’s requests for PSA tests
Navigating the existing guidance on men’s rights to a PSA can be difficult.
Current DHSC guidance tells GPs not to proactively promote the PSA test to asymptomatic men, putting the onus on men to request it themselves.
However, guidance is not consistent on whether men without symptoms have the right to a PSA test, regardless of a doctor’s clinical judgement.
‘Men aged 50 and over who decide to have a PSA test based on this balanced information [on the pros and cons of a test, discussed with their GP] can do so for free on the NHS’, states guidance dating back to 2016, as well as the Prostate Cancer UK website.
However, the patient information page on PSA tests on the NHS website states that men ‘can ask their GP for a PSA test’ but doesn’t say whether men should have their request met.
In other DHSC guidance, men are told: ‘Before making a decision, you may want to talk to your GP, practice nurse, partner, family members or friends.’
This may be why people are reporting in our poll, and to their local Healthwatch, that they don’t always have their PSA requests met.
We asked poll respondents who were aged 50 or over (1,706 in total), if they’d ever asked their GP for a PSA test and, if so, what happened. We found:
- 60% of men aged 50 and over had not requested a PSA test
- 36% of men aged 50 and over had asked for a PSA test
- Seven per cent of those who had asked for a PSA test had been refused (although due to that sample being under 100, this figure should be treated with caution).
Local Healthwatch have also heard stories of test refusals.
Research conducted by Healthwatch Worcestershire and a local cancer support group, showed 31% of 156 men surveyed, said their GP had either discouraged them from taking a PSA test or had refused to provide one. Of this group, 16 said they had told their GP they had a family history of prostate cancer.
One man told Healthwatch Birmingham he was refused a PSA test despite a family history.
“Initially I was told that I could not be tested unless I had symptoms. As my father had prostate cancer when he passed away and my younger brother has an enlarged prostate I decided to get tested and said that I had symptoms even though I didn’t [just to get a test]”.
GPs themselves have acknowledged that various or changing guidance and their own clinical judgements, can cause difficult conversations. An editorial in the British Journal of General Practice from 2023 states that GPs may be ‘mindful of the limitations of PSA in terms of the risks of both false positive and false negative results and the adverse consequences, and do not want to contribute to the problem of overdiagnosis of clinically insignificant prostate cancer. Some patients may interpret this hesitancy around PSA testing as GPs trying to dissuade or discourage them from having the test’.
Separate guidance to GPs covers how to deal with men who have symptoms of prostate problems. But this relies on men coming forward, and this is a key part of the problem.
Only 65% of the 328,885 men who replied to the most recent national GP Patient Survey said they’d had a GP appointment in the last six months, compared with 76% of women. Men were also less likely to take steps to seek help before making a GP appointment – such as speaking to family or friends or looking for information and advice online, compared with women.
A 67-year-old man told Healthwatch Sheffield his consultant had told him he’d probably escaped by only two months, a terminal diagnosis of prostate cancer, by contacting his GP when he did.
“I was lucky, my GP and consultant and their teams acted rapidly. But had I delayed in seeking help, I could have caused my own demise.”
Our calls for change
As experts on the National Screening Committee determine the best clinical approach for any future screening programme, we urge policy makers to also heed the willingness of men to come forward if invited.
Furthermore, and aside from the decision of the National Screening Committee, we call for clarity and consistency on the approach to testing men aged 50+ who have no symptoms but are seeking help. Currently, many men are left in distress when a request is denied by their GP (or their practice won’t let them book an appointment with a doctor to discuss it initially) and they don’t know what to do next.
Our three key calls for the men’s health strategy:
1.Policymakers should consider men’s views, alongside clinical and economic evidence, when reaching a decision on introducing a national prostate cancer screening programme. While the scope of a future screening programme should be left to clinical judgement, we present evidence that men – particularly higher risk Black men – would take up a screening invitation. This evidence should be considered as a decision is reached on screening over the coming months.
2. Ensure there is clear, consistent national guidance for the public and GPs on asymptomatic testing. This should make clear whether:
- men over 50 are entitled to get an appointment to discuss the pros and cons of the PSA test
- the ultimate decision to get a PSA test is the clinician’s or the patient’s
- patients can take any other action if they are refused a PSA test but they still want one.
3. Increase men's awareness of prostate cancer symptoms, and risk factors for the disease, and the importance of seeking help as soon as possible
About the survey
Savanta surveyed 3,575 men aged 18+ living in England between 13 - 27 June 2025. Data were weighted by gender, age, region and SEG (Social Economic Grade).
