Charity Warns NHS Is Overtreating Prostate Cancer—Thousands Could Avoid Surgery

A leading charity says too many men in the UK are receiving aggressive treatment for prostate cancer that would likely never cause them harm. Prostate Cancer UK estimates around 5,000 men each year undergo surgery or radiotherapy—treatments that can result in incontinence and erectile dysfunction—when many could safely choose active surveillance (regular PSA tests, scans and check-ups).

Of roughly 56,000 annual diagnoses, about 6,500 men already opt for monitoring, typically those classed at the lowest risk. The charity argues that evidence now supports extending surveillance to the next-lowest risk group as well—where about 8 in 10 show no sign of spread after five years—potentially sparing thousands the side-effects of radical treatment. It says outdated clinical guidance is a key reason uptake varies widely by hospital, with over-treatment rates ranging from 2% to 24% in England.

The National Institute for Health and Care Excellence (NICE) currently recommends surveillance only for the lowest risk cases in England and Wales but confirms it is reviewing the guideline. Prostate Cancer UK says many trusts have already expanded surveillance policies, while a quarter have not—creating a postcode lottery that leaves men facing very different choices depending on where they’re diagnosed.

Some over-treatment reflects patient preference: even low-risk patients are usually offered all options. But the charity argues that normalising surveillance would reduce harm and strengthen the case for a national screening programme—a long-debated goal that has gained fresh attention amid high-profile diagnoses. Critics of screening often cite the PSA test’s limitations and the risk of triggering unnecessary procedures. Advocates counter that better risk stratification and modern imaging can make screening safer and more targeted.

Real-world experiences underscore the trade-offs. Men who start on surveillance can still move to treatment if the disease progresses—often preserving years of quality of life before any intervention.

With NICE’s update pending, the debate turns on a simple question: for men with slow-growing disease, should “less can be more” become the national default?

BBC