{"cancerId":"prostate","aliases":["prostate-low-risk","prostate-intermediate-risk","prostate-high-risk","prostate-bcr","prostate-mhspc","prostate-nmcrpc","prostate-mcrpc","prostate-nepc"],"cancerName":"Prostate cancer","asOf":"2026-09-25","intro":"Around 57,900 men a year are diagnosed with prostate cancer in the UK and around 12,300 die of it: the second most common cancer and the second most common cause of cancer death in men, with ten-year survival of 78.9 percent. Most of the argument in the NHS is not about treatment but about whether to look. In March 2026 the UK National Screening Committee recommended a screening programme for the first time, and made it a very small one: biennial PSA testing for men aged 45 to 61 who carry a pathogenic BRCA2 variant and have a family history of breast, ovarian, pancreatic or prostate cancer. It did not recommend population screening, and it did not recommend screening Black men, whose lifetime risk of diagnosis is around one in four against one in eight for White men on Lloyd's ethnic-specific estimate, against one in six for UK men overall on Cancer Research UK's, because it judged the evidence too thin to know whether screening would help them. Ministers in England accepted the recommendation on 2 June 2026 and expect to roll the programme out in 2027. This page follows the NHS route from the age-specific PSA thresholds a GP works to, through multiparametric MRI read on a Likert scale, local anaesthetic transperineal biopsy and the Cambridge Prognostic Group, to active surveillance, surgery, radiotherapy and the drugs. It lists every NICE and Scottish Medicines Consortium decision on a prostate cancer medicine with its reference and date, including the refusals, and it gives the waiting-time figures by nation and by route, which for this cancer are the worst in the building.","presentation":[{"title":"You asked for a PSA test","detail":"The commonest way a prostate cancer is found in Britain, and the one no policy has ever formally organised. Anyone with a prostate can ask a GP about a PSA test; the NHS page says routine PSA testing is not offered unless genetic testing has shown a faulty BRCA2 gene. The Prostate Cancer Risk Management Programme, which used to give GPs the counselling framework for this conversation, has been withdrawn: its GOV.UK addresses now redirect to the NHS PSA test page. What remains is a discussion of benefits and risks, and then a test if the man still wants one. The preparation matters and is easy to get wrong: no anal sex, no ejaculation, no vigorous exercise such as cycling for 48 hours beforehand, and a wait of four to six weeks after a urine infection has cleared.","sources":[{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"},{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"}]},{"title":"Lower urinary tract symptoms, or an abnormal prostate on examination","detail":"NICE NG12 recommendation 1.6.2 tells GPs to consider a PSA test and a digital rectal examination in anyone with lower urinary tract symptoms such as getting up at night, frequency, hesitancy, urgency or retention, or with erectile dysfunction, or with visible blood in the urine. Recommendation 1.6.1 is the harder trigger and the only outright one: refer on a suspected cancer pathway if the prostate feels malignant on examination. Recommendation 1.6.3 is softer: consider referring if the PSA is above the age-specific threshold in table 2. An abnormal examination is a referral; a raised PSA is a conversation.","sources":[{"label":"NICE NG12: suspected cancer, recommendations organised by site of cancer (prostate is 1.6.1 to 1.6.3 with the age-specific PSA thresholds in table 2). Published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS: prostate cancer, tests and next steps. Page last reviewed 31 July 2025","url":"https://www.nhs.uk/conditions/prostate-cancer/tests-and-next-steps/","date":"2025-07-31"}]},{"title":"Nothing at all","share":"Most early prostate cancer causes no symptoms","detail":"The NHS page says prostate cancer often has no symptoms until it has grown large enough to press on the urethra, and that the symptoms it does cause are the same as those of a benign enlarged prostate, which is far more common. This is the whole of the screening problem in one sentence: a disease that is silent when it is curable and can be curable when it is silent, in an organ where most of what is found would never have caused harm. The screening committee's own modelling put it plainly: at age 60, about half of screen-detected cases would be overdiagnosed.","sources":[{"label":"NHS: prostate cancer","url":"https://www.nhs.uk/conditions/prostate-cancer/","date":"2026-09-25"},{"label":"UK National Screening Committee: screening for prostate cancer, coversheet of 26 March 2026 (the modelling summary by strategy, the 12-week consultation with its 974 comments, and the recommendation in full with its rationale for excluding BRCA1 carriers, Black men and family history without a BRCA2 variant)","url":"https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","date":"2026-03-26"}]},{"title":"A family history, or a BRCA2 result that came from someone else's cancer","detail":"Risk factors the NHS lists are age over 50, a Black African or African Caribbean ethnic background, a family history of prostate cancer, and a close relative with pancreatic, breast or ovarian cancer, particularly young. From 2027 one of these becomes a programme rather than a leaflet: a man found to carry a pathogenic germline BRCA2 variant, usually through cascade testing after a relative's breast or ovarian cancer, and who has a family history of breast, ovarian, pancreatic or prostate cancer, will be invited for a PSA test every two years between 45 and 61. The National Genomic Test Directory also carries R430, inherited prostate cancer, for men diagnosed under 50, men of Ashkenazi Jewish ancestry at any age, men with a grandparent from Whalsay in Shetland at any age, men with metastatic disease under 60, and men with a CanRisk score above 10 percent.","sources":[{"label":"NHS: prostate cancer, causes (the risk factors it lists are age over 50, a Black African or African Caribbean ethnic background, a family history of prostate cancer, and a close relative with pancreatic, breast or ovarian cancer). Page last reviewed 31 July 2025","url":"https://www.nhs.uk/conditions/prostate-cancer/causes/","date":"2025-07-31"},{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"},{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"},{"label":"NHS England: rare and inherited disease eligibility criteria, version 9.1 of 20 May 2026 (the R430 testing criteria: prostate cancer under 50, Ashkenazi Jewish ancestry at any age, a grandparent from Whalsay at any age, metastatic disease under 60, or a CanRisk score above 10 percent)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","date":"2026-05-20"}]},{"title":"Already spread","share":"12% of men in England and 20% in Wales were metastatic at diagnosis","detail":"The National Prostate Cancer Audit's first indicator is the share of men who already have metastatic disease when they are diagnosed. For men diagnosed in England during 2022 it was 12 percent, 5,696 of 45,599, down from 6,161 in 2021 and from 17 percent the year before; for men diagnosed in Wales between April and December 2023 it was 20 percent, 316 of 1,600. The range between English specialist multidisciplinary teams was 5 to 19 percent. This is the number a screening programme would be trying to move, and it is the one the evidence agent proposes measuring a programme against.","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, infographic","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Infographic.pdf","date":"2025-10"}]}],"timeline":[{"id":"screening","label":"Before any symptoms: what the NHS does and does not offer","standard":"No population screening. From 2027 in England, a PSA test every two years between 45 and 61 for men with a pathogenic germline BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Anyone else with a prostate can ask a GP for a PSA test after a discussion of benefits and harms","target":"Rollout expected 2027 (England); next UK NSC review estimated 2029 to 2030","detail":"The UK National Screening Committee reviewed prostate cancer screening across 2025 and 2026 and published its recommendation after a meeting on 26 March 2026. It is the first time the committee has recommended any form of prostate cancer screening, and it is deliberately narrow. It recommends a nationally managed approach to biennial PSA testing in men aged 45 to 61 with pathogenic germline BRCA2 variants and a family history of breast, ovarian, pancreatic or prostate cancer; it recommends that the best way of identifying and inviting that group be evaluated over time; and it does not recommend population screening or targeted screening for any other risk group.\n\nThe reasoning is in the committee's own coversheet. A model built by the Sheffield Centre for Health and Related Research, validated against the CAP and ERSPC trials, ran a modern pathway of PSA, then multiparametric MRI, then local anaesthetic transperineal biopsy. Screening everyone would only slightly reduce deaths while causing a very large number of men to be treated for cancer that would never have harmed them: around 40 to 50 percent of screen-detected cancers are slow growing, and at age 60 the model predicted that half of screen-detected cases would be overdiagnosed. The committee found the same problem in men with a family history but no BRCA2 variant. For men with a pathogenic BRCA2 variant and a relevant family history, repeat PSA testing was judged likely to be both clinically and cost effective at the 20,000 pound per quality-adjusted life year threshold. BRCA1 carriers were in the draft and were dropped from the final recommendation after geneticists advised that the increased risk was not large enough.\n\nThe committee consulted for twelve weeks, from 28 November 2025 to 23 February 2026, and received 974 comments. Most respondents disagreed: 834 opposed the draft, 796 of them members of the public, and the organisations opposing included the British Association of Urological Surgeons, the NHS Race and Health Observatory, the Black Equity Organisation, the Caribbean and African Health Network and Prostate Scotland. Cancer Research UK, Prostate Cancer UK, the Royal College of General Practitioners and the Royal College of Nursing agreed with it. The committee's answer to the personal accounts it received is worth reading: the stories come almost entirely from men whose cancer was found by a PSA test, and a programme has to be judged on the population it would invite.\n\nMinisters in England agreed to implement the recommendation on 2 June 2026, with rollout expected in 2027. The committee has said it will keep the model open so that new evidence, including TRANSFORM's, can be fed in, and the next review is estimated for 2029 to 2030.","sources":[{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"},{"label":"UK National Screening Committee: screening for prostate cancer, coversheet of 26 March 2026 (the modelling summary by strategy, the 12-week consultation with its 974 comments, and the recommendation in full with its rationale for excluding BRCA1 carriers, Black men and family history without a BRCA2 variant)","url":"https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","date":"2026-03-26"},{"label":"UK National Screening Committee: prostate cancer evidence review, 2026","url":"https://view-health-screening-recommendations.service.gov.uk/document/728f9536-5010-40e6-9030-748c4bd517d0/download","date":"2026-03"},{"label":"UK National Screening Committee: prostate cancer cost-effectiveness model, built by the Sheffield Centre for Health and Related Research","url":"https://view-health-screening-recommendations.service.gov.uk/document/2b9ef9db-3622-44c3-91ea-a77320d67770/download","date":"2026-03"},{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"},{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"}]},{"id":"thousand","label":"What screening would do to 1,000 men, on the committee's own numbers","standard":"Of 1,000 men aged 50 to 60 screened with a PSA test: around 100 have a positive PSA, 34 have a positive MRI and a biopsy, 28 are diagnosed with prostate cancer, up to 2 lives are saved and up to 20 are overdiagnosed, 12 of them overtreated","detail":"Cancer Research UK designed this infographic and the UK National Screening Committee calculated the figures, mostly from the GOTEBORG-2 trial for everything up to diagnosis, from the CAP and ERSPC trials for lives saved, and from ProtecT for harms. Of the 28 men diagnosed, 10 would likely be offered active surveillance, of whom around 6 switch to radiotherapy or surgery within 15 years; 13 would likely be offered surgery, radiotherapy or active surveillance, and clinical experts think many of these grade group 2 cancers are over-detected and overtreated; 4 would likely need surgery or radiotherapy and 1 some other treatment.\n\nThe harms at five years are from ProtecT and apply to every man treated, whether he needed it or not: of men who had surgery, almost 20 percent leak urine and 50 percent have erectile problems; of men who had radiotherapy, almost 40 percent have erectile problems and around 5 percent have bowel problems. Men on active surveillance are not unharmed either: the anxiety of the diagnosis and the follow-up testing, and the risk of switching to radical treatment unnecessarily or of not being treated when they need it. This table is the honest version of the screening argument and it is published by the committee, not by its critics.","sources":[{"label":"UK National Screening Committee and Cancer Research UK: modelling the outcomes of prostate cancer screening (what happens to 1,000 men aged 50 to 60 screened with PSA, with its assumptions and references)","url":"https://view-health-screening-recommendations.service.gov.uk/document/90900396-f2b5-4ce5-a25f-07351a4057b0/download","date":"2026-04-16"},{"label":"UK National Screening Committee: screening for prostate cancer, coversheet of 26 March 2026 (the modelling summary by strategy, the 12-week consultation with its 974 comments, and the recommendation in full with its rationale for excluding BRCA1 carriers, Black men and family history without a BRCA2 variant)","url":"https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","date":"2026-03-26"}]},{"id":"blackmen","label":"Risk in Black men, and what the NHS does about it","standard":"No different NHS pathway. Prostate Cancer UK recommends Black men over 45 discuss their risk and a PSA test with a GP; a 2024 UK clinical consensus says the same; NICE says only that a black African-Caribbean family background is one of the risk factors to discuss when deciding about a biopsy","detail":"The figures are real and old. Lloyd and colleagues, working with Public Health England and Prostate Cancer UK, calculated lifetime risk by major ethnic group from England's 2008 to 2010 incidence and mortality: a 29.3 percent lifetime risk of diagnosis in Black men (range 23.5 to 37.2) against 13.3 percent in White men (13.2 to 15.0) and 7.9 percent in Asian men, which is where one in four against one in eight comes from. Lifetime risk of dying of prostate cancer was 8.7 percent in Black men against 4.2 percent in White men. Delon and colleagues put the modern incidence rate ratio at 2.1 for Black against White males in England for 2013 to 2017, and showed it is strongly age-dependent: 2.9 times higher at ages 0 to 64 and 1.9 times higher at 65 and over. The government's own equality impact assessment gives the age-standardised incidence rate as 166 per 100,000 in Black men against 56.4 in White men, with a 30 percent higher mortality rate.\n\nThe most important finding in the Lloyd paper is the one least often quoted. Within every ethnic group the ratio of lifetime death risk to lifetime diagnosis risk was close to one third, so once a man has been diagnosed his chance of dying of the disease is about the same whatever his ethnicity. The excess is in incidence, not in case fatality. What the NHS does about it is almost nothing formal. NICE NG131 recommendation 1.2.6, unchanged since 2008, lists a black African-Caribbean family background among the risk factors to weigh when deciding about MRI or biopsy; there is no recommendation anywhere in NG131 or NG12 for earlier or more frequent PSA discussion by ethnicity. The recommendation that Black men be proactively offered that discussion from 45 comes from a 2024 UK clinical consensus published in the British Journal of General Practice, and from Prostate Cancer UK, not from NICE or from a screening programme. The screening committee's position is that the balance of benefit and harm in Black men is unknown, because too few Black men have been recruited into screening trials, and that TRANSFORM is the way to find out.","sources":[{"label":"Lloyd T, Hounsome L, Mehay A, Mee S, Verne J, Cooper A. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Medicine 2015;13:171. The source of the one-in-four figure, with the ranges and the finding that case fatality is the same in every ethnic group","url":"https://europepmc.org/article/MED/26224061","date":"2015-07-30"},{"label":"Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. British Journal of Cancer 2022;126:1765-1773. Prostate cancer incidence rate ratio, Black against White males, 2.1 overall, 2.9 at ages 0 to 64 and 1.9 at 65 and over","url":"https://europepmc.org/article/MED/35233070","date":"2022-03-01"},{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"Harding TA, Martin RM and others. Optimising the use of the prostate-specific antigen blood test in asymptomatic men for early prostate cancer detection in primary care: report from a UK clinical consensus. British Journal of General Practice 2024;74(745):e534-e543. The consensus, not NICE, is the source of the advice that PSA testing should be proactively discussed with Black men from 45","url":"https://europepmc.org/article/MED/39054088","date":"2024-07-23"},{"label":"Prostate Cancer UK: Black men and prostate cancer. One in four Black men will get prostate cancer, double the risk of other men; risk rises from 45; and the charity recommends Black men over 45 speak to their GP about their risk and about having a PSA test","url":"https://prostatecanceruk.org/prostate-information-and-support/risk-and-symptoms/black-men-and-prostate-cancer","date":"2026-09-25"},{"label":"UK National Screening Committee: screening for prostate cancer, coversheet of 26 March 2026 (the modelling summary by strategy, the 12-week consultation with its 974 comments, and the recommendation in full with its rationale for excluding BRCA1 carriers, Black men and family history without a BRCA2 variant)","url":"https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","date":"2026-03-26"}]},{"id":"referral","label":"Day 0: the PSA threshold that triggers a referral","standard":"Refer on a suspected cancer pathway if the prostate feels malignant on digital rectal examination (NG12 1.6.1). Consider referring if the PSA is above the age-specific threshold in NG12 table 2: more than 2.5 micrograms per litre at 40 to 49, 3.5 at 50 to 59, 4.5 at 60 to 69 and 6.5 at 70 to 79, with clinical judgement below 40 and above 79","detail":"The age-specific table came into NG12 in the December 2021 update, replacing a single fixed threshold, and the April 2026 update did not touch it. Two details are easy to get backwards and both matter. First, an abnormal digital rectal examination is a referral, not a consideration: recommendation 1.6.1 says refer. A raised PSA is only a consideration, because recommendation 1.6.3 says consider referring, taking the person's preferences and comorbidities into account. Second, this table is for men with possible symptoms, which recommendation 1.6.2 defines as any lower urinary tract symptom, erectile dysfunction or visible haematuria. NICE has no threshold for an asymptomatic man, because NICE has never written guidance on screening; that was the withdrawn risk management programme's job and is now the screening committee's. NG131 recommendation 1.2.6 adds the rule that keeps the pathway honest: do not automatically offer a biopsy on the basis of the PSA alone.","sources":[{"label":"NICE NG12: suspected cancer, recommendations organised by site of cancer (prostate is 1.6.1 to 1.6.3 with the age-specific PSA thresholds in table 2). Published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"}]},{"id":"fds","label":"28 days: diagnosis or all-clear","standard":"Faster Diagnosis Standard: told you have cancer, or that you do not, within 28 days of the referral","target":"80% from quarter 1 of 2026/27","detail":"Suspected urological cancer excluding testicular is the worst-performing tumour group in England on this standard. In July 2026, 15,077 of 22,234 people were told within 28 days, or 67.8 percent, against 79.3 percent across all cancers, a gap of eleven and a half points. The referral volume is large and growing: 24,449 urgent suspected cancer referrals for suspected urological malignancy in that single month. The reason the standard is hard here is structural rather than clinical. A prostate pathway needs a PSA, a clinic appointment, a multiparametric MRI reported by a radiologist confident enough to give a Likert score, and then, for most men with a Likert 3 or more, a biopsy under local anaesthetic through the perineum and a pathologist to grade it. Every one of those steps is a queue.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"NHS England: cancer waiting times statistical release for July 2026, provider based, provisional (released 10 September 2026)","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Cancer-Waiting-Times-Statistical-Release-July-2026-Provider-based-Provisional.pdf","date":"2026-09-10"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"NHS England: cancer waiting times statistics","url":"https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/"}]},{"id":"mri","label":"Multiparametric MRI, before any needle","standard":"Multiparametric MRI as the first-line investigation for suspected clinically localised prostate cancer, reported on a 5-point Likert scale (NG131 1.2.2). MRI-influenced biopsy if the Likert score is 3 or more (1.2.3). Consider omitting biopsy at Likert 1 or 2 after a shared decision (1.2.4)","detail":"This is the British contribution to prostate cancer diagnosis and it is built on PROMIS, a UK study that gave 576 men an MRI, a standard transrectal biopsy and a template mapping biopsy and compared all three. Multiparametric MRI had a sensitivity of 93 percent for clinically significant cancer against 48 percent for the standard biopsy, and using it as a triage test would spare 27 percent of men a primary biopsy while finding up to 18 percent more clinically significant cancers. NG131 recommendation 1.2.1 sets the limit: do not routinely offer MRI to someone who would not be able to have radical treatment anyway.\n\nNote what the NHS reports and what it does not. NICE asks for a five-point Likert score, which is a radiologist's overall judgement, not a PI-RADS category; PI-RADS is used internationally and in research but the NHS standard as written by NICE is Likert. Box 1 of NG131 gives the numbers for the conversation after a Likert 1 or 2 scan: between 11 and 28 in 100 men with a low-risk MRI actually have clinically significant cancer, prostate biopsies find less than half of the clinically significant cancers MRI misses, and between 18 and 23 in 100 get a diagnosis of clinically insignificant cancer if they are biopsied. If no biopsy is done, recommendation 1.2.11 asks for a repeat PSA at three to six months and sets the re-referral triggers: a PSA density above 0.15 nanograms per millilitre per millilitre or a PSA velocity above 0.75 nanograms per millilitre per year, or a strong family history.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"Ahmed HU and others. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-822 (PMID 28110982)","url":"https://europepmc.org/article/MED/28110982","date":"2017-02-25"},{"label":"NICE HTG678 (formerly DG53): MRI fusion biopsy systems for diagnosing prostate cancer (24 May 2023). There is not enough evidence to recommend routine adoption; centres already using them may continue but are asked to collect data","url":"https://www.nice.org.uk/guidance/htg678","date":"2023-05-24"}]},{"id":"biopsy","label":"The biopsy, and why it is now through the perineum","standard":"Local anaesthetic transperineal biopsy with a freehand needle positioning device is recommended as an option (NICE HTG680). NG131 1.2.5 says do not offer mapping transperineal template biopsy as part of an initial assessment outside a clinical trial","detail":"NG131 itself makes no recommendation between transrectal and transperineal biopsy, and says so: box 1's figures come from PROMIS and ProtecT, which used transrectal ultrasound-guided biopsy, and NICE states there is no equivalent data for other types. The move to the perineum was made by a separate piece of NICE guidance, HTG680, formerly diagnostics guidance DG54, published 1 June 2023. It recommends local anaesthetic transperineal biopsy using the PrecisionPoint freehand device, and three other freehand devices with less evidence behind them, on the basis that cancer detection is no different but infection and sepsis are less common. It found the evidence insufficient to recommend the CamPROBE double freehand device, and it asked centres to join TRANSLATE, the randomised comparison of transrectal against local anaesthetic transperineal biopsy.\n\nThe harms NG131 lists for transrectal biopsy are the reason this mattered: sepsis in a little under 1 in 100, 44 in 100 reporting pain, 20 in 100 a fever, 66 in 100 blood in the urine and 90 in 100 blood in the semen, which lasts more than two weeks in 60 of them. Template mapping biopsy, taking two or three cores from each of 20 sites, stays where it was: HTG237 supports it after a negative or equivocal biopsy, and NG131 1.2.5 keeps it out of the initial assessment. MRI fusion biopsy systems are not recommended for routine adoption: HTG678 says the evidence is not there and asks centres already using them to collect data.","sources":[{"label":"NICE HTG680 (formerly DG54): transperineal biopsy for diagnosing prostate cancer (1 June 2023). Local anaesthetic transperineal biopsy with the PrecisionPoint freehand device is recommended, with three other freehand devices, and centres are asked to join the TRANSLATE randomised comparison with transrectal biopsy","url":"https://www.nice.org.uk/guidance/htg680","date":"2023-06-01"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE HTG237 (formerly IPG364): transperineal template biopsy and mapping of the prostate (27 October 2010). Increased diagnostic yield after a negative or equivocal biopsy; use as a mapping technique for focal therapy or inside active surveillance needs special arrangements","url":"https://www.nice.org.uk/guidance/htg237","date":"2010-10-27"},{"label":"NICE HTG678 (formerly DG53): MRI fusion biopsy systems for diagnosing prostate cancer (24 May 2023). There is not enough evidence to recommend routine adoption; centres already using them may continue but are asked to collect data","url":"https://www.nice.org.uk/guidance/htg678","date":"2023-05-24"}]},{"id":"mdt","label":"The urological cancer multidisciplinary team, and the Cambridge Prognostic Group","standard":"Urological cancer multidisciplinary teams should assign a risk category to everyone with newly diagnosed localised or locally advanced prostate cancer, using the Cambridge Prognostic Group table (NG131 1.2.15). Do not routinely offer isotope bone scans in CPG 1 or 2 (1.2.16)","detail":"NICE replaced its own three-tier low, intermediate and high risk table in the December 2021 amendment and its whole treatment section is now written in Cambridge Prognostic Group numbers. CPG 1 is Gleason 6, grade group 1, with a PSA below 10 and stage T1 to T2. CPG 2 is Gleason 3+4 or a PSA of 10 to 20, with stage T1 to T2. CPG 3 is Gleason 3+4 and a PSA of 10 to 20 and stage T1 to T2, or Gleason 4+3 at stage T1 to T2. CPG 4 is one of Gleason 8, a PSA above 20, or stage T3. CPG 5 is two or more of those, or Gleason 9 to 10, or stage T4. Roughly, CPG 1 maps to what used to be called low risk, CPG 2 and 3 to intermediate and CPG 4 and 5 to high, but the boundaries are not identical and NICE's recommendations are written in the new numbers, so it is worth knowing which group you are in rather than which band. Note that the table uses micrograms per litre while other NG131 recommendations use nanograms per millilitre; the two are the same quantity.\n\nStaging follows from the group. Bone scans are not routine in CPG 1 or 2. NG131 says nothing at all about PSMA PET-CT: NICE considered it in a 2023 exceptional surveillance review, noted a study reporting 27 percent greater accuracy than conventional imaging and topic experts' concern about geographical inequity in access, and decided not to change the bone-scan recommendations. Any claim that NICE recommends PSMA or choline PET-CT at a given PSA after relapse is not NICE; it is European Association of Urology guidance.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE: 2023 exceptional surveillance of NG131 (2 March 2023), which decided not to update the bone-scan recommendations and said it would continue monitoring the evidence on gallium-68 PSMA PET-CT","url":"https://www.nice.org.uk/guidance/ng131/resources/2023-exceptional-surveillance-of-prostate-cancer-diagnosis-and-management-nice-guideline-ng131-pdf-14749949286853","date":"2023-03-02"},{"label":"NICE QS91: prostate cancer, quality standard, five statements (published 11 June 2015, last updated 30 December 2021)","url":"https://www.nice.org.uk/guidance/qs91","date":"2021-12-30"}]},{"id":"dtt","label":"31 days: decision to first treatment","standard":"Treatment starts within 31 days of the decision to treat","target":"96% (England); 95% (Scotland); 98% (Northern Ireland)","detail":"Prostate cancer does comparatively well on this measure, which is the one that starts once the queue for diagnosis is behind you. In England in July 2026, 8,244 of 9,015 prostate treatments started within 31 days, or 91.4 percent, against 92.5 percent for all cancers; split by stage it was 96.7 percent for first treatments and 86.4 percent for subsequent ones, and across April to July 2026 the prostate figure was 90.8 percent. In Scotland in the quarter to 31 March 2026, 1,478 of 1,612 prostate referrals were treated within 31 days, 91.7 percent, with a median wait of two days against an all-cancer figure of 94.5 percent. Northern Ireland publishes urological cancer as one group: 179 of 204 in January 2026, 172 of 200 in February and 171 of 204 in March, against a 98 percent target.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Northern Ireland Department of Health: cancer waiting times statistics by HSC trust and tumour site, January to March 2026. Urological cancer 31-day performance: 179 of 204 in January, 172 of 200 in February and 171 of 204 in March, against a 98 percent target","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-q4-25-26.xlsx","date":"2026-07-02"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"}]},{"id":"sixtytwo","label":"62 days: referral to first treatment, the standard prostate cancer fails worst","standard":"First treatment within 62 days of the urgent referral","target":"85% (England); 95% (Scotland); 75% (Wales); 95% (Northern Ireland)","detail":"In England in July 2026, 2,888 of 4,234 men with prostate cancer started treatment within 62 days, 68.2 percent, against 71.2 percent across all cancers. The route matters more here than in most cancers: 62.8 percent on the urgent suspected cancer route, 85.2 percent on the consultant upgrade route, and only three men came through a screening route at all. Across April to July 2026 the prostate figure was 65.8 percent on 16,781 treatments, against 70.2 percent for all cancers.\n\nScotland's figure is far worse and is the single most striking number on this page. In the quarter to 31 March 2026, 415 of 1,044 men with prostate cancer started treatment within 62 days: 39.8 percent, against a 95 percent standard and an all-cancer figure of 72.2 percent. Urology as a whole was 47.5 percent, the worst of any tumour group. The median wait was 77 days and the longest was 336. The spread between boards is extraordinary: 10.5 percent in NHS Grampian, where the median wait was 160 days, and 17.3 percent in NHS Lothian, against 81.1 percent in NHS Lanarkshire and 66.7 percent in NHS Highland.\n\nThe two figures are not directly comparable and should not be read as a league table. England stops the 62-day clock for men in the lower Cambridge Prognostic Groups at the point active monitoring is agreed, counting that as a first treatment; it could not be established whether Scotland or Wales do the same, because neither publication mentions active monitoring at all. Wales publishes no tumour-site figure: 60.1 percent of all suspected cancer pathways started treatment within 62 days in July 2026, against a 75 percent target, on 2,248 treatments and 18,429 new pathways opened. Northern Ireland withheld its 62-day figures from the March 2026 release and republished the whole series on 11 September 2026 after finding an error in its new patient administration system's suspension logic: the corrected all-cancer performance for the quarter to March 2026 is 29.6 percent, and every quarter since December 2024 was revised down, by as much as 4.5 percentage points.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (published 30 June 2026): 72.2 percent of 4,668 eligible referrals started treatment within 62 days, against a 95 percent standard met by no NHS board, and 94.5 percent within 31 days","url":"https://publichealthscotland.scot/publications/cancer-waiting-times/cancer-waiting-times-1-january-to-31-march-2026/","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 2,248 pathways started treatment in July and 60.1 percent started within 62 days of first being suspected of cancer, against a 75 percent target; 18,429 new suspected cancer pathways were opened, the second highest since records began. No prostate-specific figure is published","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"Northern Ireland Department of Health: revised 62-day waits for quarters ending December 2023 to March 2026 (published 11 September 2026), after an error in the encompass patient administration system's suspension logic inflated performance: 29.6 percent in the quarter to 31 March 2026, and every earlier quarter revised down by up to 4.5 percentage points","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"}]},{"id":"surveillance","label":"Active surveillance, which is a treatment decision and not a delay","standard":"Offer active surveillance in CPG 1; offer a choice of active surveillance, radical prostatectomy or radical radiotherapy in CPG 2; consider it in CPG 3; do not offer it in CPG 4 or 5 (NG131 1.3.8 to 1.3.11). The protocol in table 2: PSA every 3 to 4 months in year 1, a digital rectal examination at 12 months and MRI at 12 to 18 months, then PSA every 6 months and an examination every 12","detail":"NG131 gives active surveillance to CPG 1 as the offer, not as an option of last resort, and box 2 of the guideline explains why in ProtecT's numbers: at ten years, 98 in 100 men offered active monitoring had not died of prostate cancer, against 99 in 100 offered surgery and 99 in 100 offered radiotherapy. What differed was progression (21 against 8 and 8 in 100) and metastasis (8 against 3 and 3). What also differed was harm: at six months, moderate to severe urinary incontinence was reported by 4 in 100 on active monitoring, 19 after surgery and 6 after radiotherapy, and moderate or severe erectile dysfunction by 29, 66 and 48. Recommendation 1.3.13 asks for an MRI for anyone on surveillance who has not had one, and a new MRI-influenced biopsy if the scan and the biopsy disagree.\n\nThe audit measures this inversely and finds the largest variation on the page. Its second indicator is the proportion of men with CPG 1 localised cancer who nonetheless receive radical treatment, where lower is better: 7 percent nationally in England, 383 of 5,453 men diagnosed in 2022, but ranging from 2 to 40 percent between the 45 specialist multidisciplinary teams. A twentyfold spread on a decision that NICE has written down.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"Hamdy FC and others. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine 2023;388:1547-1558 (PMID 36912538)","url":"https://europepmc.org/article/MED/36912538","date":"2023-03-11"}]},{"id":"radical","label":"Surgery and radiotherapy, and what the NHS commissions","standard":"Offer radical prostatectomy or radical radiotherapy in CPG 3, 4 and 5 (NG131 1.3.10 and 1.3.12). Hypofractionated radiotherapy of 60 Gy in 20 fractions with image-guided intensity modulated radiation therapy (1.3.19). Six months of androgen deprivation therapy with radical radiotherapy in CPG 2 to 5 (1.3.22), with continuing it for up to three years in CPG 4 and 5 to be considered and discussed (1.3.23)","detail":"The 60 Gy in 20 fractions schedule is British: CHHiP randomised 3,216 men across 71 centres between 74 Gy in 37 fractions, 60 Gy in 20 and 57 Gy in 19, and found 60 Gy non-inferior with no extra late toxicity, cutting a seven and a half week course to four. In June 2026 NHS England went further and made stereotactic ablative radiotherapy, five fractions of 36.25 Gy over one to two weeks, a routinely commissioned option for low and intermediate risk localised disease in men who do not need androgen deprivation therapy. That policy is written on PACE-B's eligibility criteria and cites the trial by name; it excludes Gleason 4+3, an international prostate symptom score of 20 or more, and anything above intermediate risk, and it requires a centre to have at least two subspecialist clinical oncologists with prostate SABR experience and to pass radiotherapy trials quality assurance before offering it. NHS England expects it at all 48 English radiotherapy providers and estimates around 3,500 men a year will choose it.\n\nOn the surgical side, NG131 recommendations 1.3.17 and 1.3.18 ask commissioners to consider providing robotic surgery and to base robotic systems in centres expected to do at least 150 robot-assisted laparoscopic radical prostatectomies a year. Volumes are rising fast: England did 9,590 radical prostatectomies in 2024, 13 percent more than in 2023, and 20,782 courses of radical radiotherapy, also 13 percent more. The audit's third indicator asks the opposite question to its second: only 69 percent of men in England with high-risk or locally advanced disease received radical treatment within twelve months, 12,333 of 17,966, ranging from 46 to 87 percent between teams.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"Dearnaley D and others. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncology 2016;17:1047-1060 (PMID 27339115)","url":"https://europepmc.org/article/MED/27339115","date":"2016-08-01"},{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"},{"label":"NHS England: the NHS is to offer multi-beam precision radiotherapy to thousands with prostate cancer (10 June 2026), which says around 17,500 men a year in England are diagnosed with low or intermediate risk disease, that modelling suggests around 3,500 a year will choose stereotactic ablative radiotherapy, and that it is expected to be offered at all 48 radiotherapy providers in England","url":"https://www.england.nhs.uk/2026/06/nhs-to-offer-multi-beam-precision-radiotherapy-to-thousands-with-prostate-cancer/"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"NHS England clinical commissioning policy B14/P/a: robotic-assisted surgical procedures for prostate cancer, October 2015. Robotic surgery is commissioned from networked centres undertaking at least 150 robot-assisted laparoscopic radical prostatectomies a year, with a recognised training programme and participation in the national audit. Its own stated review date was April 2017 and no successor policy could be found","url":"https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/10/b14pa-rbtic-asstd-srgry-prostate-cancer-oct15.pdf","date":"2015-10"}]},{"id":"adt","label":"Hormone therapy, its side effects and the bone rule most people get wrong","standard":"Consider intermittent androgen deprivation therapy for long-term use, with PSA every 3 months and restart at 10 nanograms per millilitre (NG131 1.4.1 and 1.4.2). Offer supervised resistance and aerobic exercise at least twice a week for 12 weeks (1.4.19)","detail":"NG131 devotes a whole section to living on androgen deprivation therapy rather than to the drug itself. Hot flushes: medroxyprogesterone 20 mg a day for ten weeks first, cyproterone acetate 50 mg twice a day for four weeks if that fails. Gynaecomastia from long-term bicalutamide: prophylactic radiotherapy to both breast buds within the first month, a single fraction of 8 Gy. Fatigue: tell people it is a side effect of the treatment and not necessarily the cancer, and offer supervised exercise twice a week for twelve weeks. Sexual function: phosphodiesterase type 5 inhibitors, then vacuum devices, intraurethral inserts, injections or prostheses, and a route to psychosexual counselling.\n\nThe bone recommendations are four separate ones and are easy to run together. Do not routinely offer bisphosphonates to prevent osteoporosis in men on androgen deprivation therapy (1.4.12); do consider assessing fracture risk (1.4.13); do offer bisphosphonates to men on androgen deprivation therapy who have osteoporosis (1.4.14), with denosumab if bisphosphonates are contraindicated or not tolerated (1.4.15). Separately, do not offer bisphosphonates to prevent bone metastases (1.3.35), and in hormone-relapsed metastatic disease consider zoledronic acid to prevent skeletal-related events (1.5.19) and bisphosphonates for pain when analgesics and palliative radiotherapy have not worked (1.5.20).","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"}]},{"id":"followup","label":"Follow-up, and what a rising PSA does and does not mean","standard":"Check PSA no earlier than 6 weeks after radical treatment, at least every 6 months for the first 2 years, then at least once a year (NG131 1.3.47). Consider remote follow-up after at least 6 months if the PSA is stable (1.3.49)","detail":"NG131 is unusually restrained about biochemical relapse and this is the part of the guideline a man is most likely to need. Recommendation 1.3.55 says a rising PSA alone should not mean an immediate change in treatment. Recommendation 1.3.56 says estimate the PSA doubling time from a minimum of three measurements over at least six months. Recommendation 1.3.59 says do not routinely offer hormonal therapy for biochemical relapse unless there is symptomatic local progression, proven metastases, or a PSA doubling time of less than three months. Recommendation 1.3.57 offers radical radiotherapy to the prostatic bed after prostatectomy where there are no known metastases, and 1.3.54 says do not offer routine MRI before salvage radiotherapy, but do offer an isotope bone scan if symptoms or the PSA trend suggest metastases. Recommendation 1.3.48 says do not routinely do a digital rectal examination in localised disease while the PSA is at baseline.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"}]},{"id":"advanced","label":"Hormone-relapsed disease, which NICE does not call castration-resistant","standard":"Discuss treatment options for hormone-relapsed disease at the urological cancer multidisciplinary team and seek an oncologist or specialist palliative care opinion (NG131 1.5.11). Offer docetaxel within 12 weeks of starting androgen deprivation therapy in newly diagnosed metastatic disease (1.5.6)","detail":"NICE's heading throughout NG131 is hormone-relapsed rather than castration-resistant; the two terms mean the same thing and the older one is still used everywhere else, including on the drug labels. The funding table below sets out what is available by line. Two things about the British version of this pathway are distinctive. First, upfront docetaxel for newly diagnosed metastatic disease came from STAMPEDE and was commissioned by NHS England through a policy statement in January 2016, not through a technology appraisal; NG131 carries it as recommendation 1.5.6; 1.3.26 is the parallel recommendation for high-risk non-metastatic disease.\n\nSecond, the audit finds the largest inequity on the page here, and it is by age. Among men in England with newly diagnosed hormone-sensitive metastatic disease, 66 percent of those under 75 received systemic treatment intensification within twelve months, 1,803 of 2,728, ranging from 39 to 87 percent between teams; among men aged 75 and over it was 29 percent, 867 of 2,951, ranging from 11 to 57 percent. Overall only 47 percent of English men received intensification. The audit's third recommendation asks providers to use individualised assessment such as a comprehensive geriatric assessment and not to deny investigation or treatment on chronological age alone.","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"NHS England clinical commissioning policy statement: docetaxel with androgen deprivation therapy for hormone-naive metastatic prostate cancer (22 January 2016), the commissioning route that put the STAMPEDE docetaxel result into practice without a technology appraisal","url":"https://www.england.nhs.uk/publication/clinical-commissioning-policy-statement-docetaxel-in-combination-with-androgen-deprivation-therapy-for-the-treatment-of-hormone-naive-metastatic-prostate-cancer/","date":"2016-01-22"}]},{"id":"complications","label":"What the treatment does afterwards, and who is meant to fix it","standard":"Offer access to specialist erectile dysfunction services and to specialist continence services after radical treatment (NG131 1.3.36 and 1.3.39). NICE quality standard QS91 statement 4: people with adverse effects of prostate cancer treatment are referred to specialist services","detail":"The audit added a new indicator for 2025 and it is the one that tells a man what the next two years may hold. Within two years of radical prostatectomy, 6 percent of men in England needed a procedural or surgical intervention for a genitourinary complication, 395 of 6,357, ranging from 0 to 21 percent between providers. Within two years of radical radiotherapy, 8 percent had a large bowel procedure with a diagnosis indicating radiation toxicity, 1,092 of 13,329, ranging from 0 to 16 percent, and 6 percent needed an intervention for a genitourinary complication, 752 of 13,364, ranging from 2 to 17 percent. Twelve percent of men had an emergency readmission within 90 days of radical prostatectomy, 1,060 of 8,868, ranging from 5 to 25 percent.\n\nNG131 sets out what should happen: specialist erectile dysfunction services, phosphodiesterase type 5 inhibitors and then vacuum devices, intraurethral inserts, injections or a prosthesis; specialist continence services with pelvic floor re-education and bladder retraining, and referral to a specialist surgeon for an artificial urinary sphincter in intractable stress incontinence, with bulking agents explicitly not offered. For radiation-induced enteropathy it asks for a team with expertise in it, and for full investigation including flexible sigmoidoscopy. QS91 statement 4 makes the referral itself the quality measure. The audit's second recommendation asks providers to review their variation and to make sure onward referral to those services actually happens.","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE QS91: prostate cancer, quality standard, five statements (published 11 June 2015, last updated 30 December 2021)","url":"https://www.nice.org.uk/guidance/qs91","date":"2021-12-30"}]}],"centres":[{"institutionId":"uclh","name":"University College Hospital and the Westmoreland Street site","trust":"University College London Hospitals NHS Foundation Trust","city":"London","nation":"England","offers":["The largest radical prostatectomy service in England: 727 operations between April 2023 and March 2024, more than half as many again as the next centre","Home of PROMIS, the study that put MRI before biopsy, and of the UCL urology and targeted intervention programme","Co-sponsor of TRANSFORM and of STAMPEDE2 through the MRC Clinical Trials Unit at UCL"],"url":"https://www.uclh.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Ahmed HU and others. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-822 (PMID 28110982)","url":"https://europepmc.org/article/MED/28110982","date":"2017-02-25"},{"label":"ISRCTN13801649: TRANSFORM, trial of randomised approaches for national screening for men. Stage 1 recruitment from 21 November 2025, target 16,000; two pre-consent randomisation designs allocating men to one of four prostate health checks or to a control group; principal investigator Hashim Ahmed","url":"https://www.isrctn.com/ISRCTN13801649","date":"2025-12-30"}],"institutionName":"University College London Hospitals / UCL Cancer Institute"},{"institutionId":"royal-surrey-guildford","name":"Royal Surrey County Hospital","trust":"Royal Surrey NHS Foundation Trust","city":"Guildford","nation":"England","offers":["448 radical prostatectomies between April 2023 and March 2024, the second highest in England, with one of the lowest adjusted 90-day readmission rates at 6.4 percent","386 courses of radical prostate radiotherapy in the audit's 2021 to 2022 window"],"url":"https://www.royalsurrey.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"}],"institutionName":"Royal Surrey County Hospital, Guildford"},{"name":"Broomfield and Southend Hospitals","trust":"Mid and South Essex NHS Foundation Trust","city":"Chelmsford","nation":"England","offers":["335 radical prostatectomies between April 2023 and March 2024, the third highest in England"],"url":"https://mse.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"}]},{"name":"Southmead Hospital","trust":"North Bristol NHS Trust","city":"Bristol","nation":"England","offers":["320 radical prostatectomies between April 2023 and March 2024, the regional robotic centre for the Bristol area"],"url":"https://www.nbt.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"}]},{"institutionId":"southampton-cancer","name":"University Hospital Southampton","trust":"University Hospital Southampton NHS Foundation Trust","city":"Southampton","nation":"England","offers":["320 radical prostatectomies and 200 courses of radical prostate radiotherapy in the audit's windows","Sponsor of INTENSIFY, the Prostate Cancer UK trial testing added docetaxel where the PSA does not fall far enough on hormone therapy"],"url":"https://www.uhs.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"ISRCTN17215075: INTENSIFY, adding docetaxel in metastatic hormone-sensitive prostate cancer with a persistent PSA after six months of androgen deprivation therapy and an androgen receptor pathway inhibitor","url":"https://www.isrctn.com/ISRCTN17215075","date":"2026-09-25"}],"institutionName":"University Hospital Southampton / Centre for Cancer Immunology"},{"institutionId":"guys-st-thomas","name":"Guy's Hospital","trust":"Guy's and St Thomas' NHS Foundation Trust","city":"London","nation":"England","offers":["301 radical prostatectomies between April 2023 and March 2024 and 369 courses of radical prostate radiotherapy","One of the longest-running robotic prostatectomy services in the UK"],"url":"https://www.guysandstthomas.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"}],"institutionName":"Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre"},{"institutionId":"leeds-cancer-centre","name":"St James's University Hospital and the St James's Institute of Oncology","trust":"Leeds Teaching Hospitals NHS Trust","city":"Leeds","nation":"England","offers":["692 courses of radical prostate radiotherapy in the audit's window, the highest in England","One of the few centres offering both low dose rate seed brachytherapy and high dose rate brachytherapy for prostate cancer","Sponsor of POINTER-PC, the trial of nodal radiotherapy against stereotactic radiotherapy for nodal recurrence"],"url":"https://www.leedsth.nhs.uk/services/radiotherapy/brachytherapy/prostate-brachytherapy/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Leeds Teaching Hospitals NHS Trust: prostate brachytherapy at the St James's Institute of Oncology, offering both low dose rate seed implants and high dose rate brachytherapy","url":"https://www.leedsth.nhs.uk/services/radiotherapy/brachytherapy/prostate-brachytherapy/","date":"2026-09-25"},{"label":"ISRCTN11089334: POINTER-PC, extended nodal irradiation against stereotactic body radiotherapy for nodal recurrence","url":"https://www.isrctn.com/ISRCTN11089334","date":"2026-09-25"}],"institutionName":"Leeds Cancer Centre, St James's University Hospital"},{"institutionId":"the-christie","name":"The Christie","trust":"The Christie NHS Foundation Trust","city":"Manchester","nation":"England","offers":["602 courses of radical prostate radiotherapy in the audit's window, with the second lowest adjusted genitourinary complication rate of any high-volume centre at 2.6 percent","117 radical prostatectomies between April 2023 and March 2024","Low dose rate permanent seed brachytherapy, and an MR-Linac"],"url":"https://www.christie.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"The Christie NHS Foundation Trust","url":"https://www.christie.nhs.uk/","date":"2026-09-25"}],"institutionName":"The Christie NHS Foundation Trust"},{"institutionId":"clatterbridge","name":"The Clatterbridge Cancer Centre","trust":"The Clatterbridge Cancer Centre NHS Foundation Trust","city":"Liverpool","nation":"England","offers":["580 courses of radical prostate radiotherapy in the audit's window","A PACE-B site, and one of the first centres delivering prostate stereotactic ablative radiotherapy under the 2026 commissioning policy"],"url":"https://www.clatterbridgecc.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"},{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"}],"institutionName":"The Clatterbridge Cancer Centre NHS Foundation Trust"},{"institutionId":"weston-park-sheffield","name":"Royal Hallamshire Hospital and Weston Park Cancer Centre","trust":"Sheffield Teaching Hospitals NHS Foundation Trust","city":"Sheffield","nation":"England","offers":["527 courses of radical prostate radiotherapy and 202 radical prostatectomies in the audit's windows","Robotic prostatectomy on a da Vinci Xi system installed in 2024"],"url":"https://www.sth.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Sheffield Teaching Hospitals NHS Foundation Trust","url":"https://www.sth.nhs.uk/","date":"2026-09-25"}],"institutionName":"Weston Park Cancer Centre, Sheffield Teaching Hospitals"},{"institutionId":"newcastle-cancer-centre","name":"Freeman Hospital and the Northern Centre for Cancer Care","trust":"The Newcastle upon Tyne Hospitals NHS Foundation Trust","city":"Newcastle upon Tyne","nation":"England","offers":["467 courses of radical prostate radiotherapy and 203 radical prostatectomies in the audit's windows","A PACE-B site; robotic prostatectomy for the north east"],"url":"https://www.newcastle-hospitals.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"}],"institutionName":"Newcastle Cancer Centre / Northern Centre for Cancer Care"},{"institutionId":"royal-marsden","name":"The Royal Marsden","trust":"The Royal Marsden NHS Foundation Trust","city":"London and Sutton","nation":"England","offers":["427 courses of radical prostate radiotherapy and 177 radical prostatectomies in the audit's windows","Lead centre for PACE-B and PACE-C, the trials behind five-fraction prostate radiotherapy; the UK's first MR-Linac and a CyberKnife service","The Institute of Cancer Research's oncogenetics and drug development programmes, and the Man Van community PSA testing project"],"url":"https://www.royalmarsden.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"},{"label":"NIHR Be Part of Research: the Man Van project, community outreach PSA testing run from The Royal Marsden","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=Man%20Van%20prostate","date":"2026-09-25"}],"institutionName":"The Royal Marsden"},{"institutionId":"addenbrookes-cambridge","name":"Addenbrooke's Hospital","trust":"Cambridge University Hospitals NHS Foundation Trust","city":"Cambridge","nation":"England","offers":["423 courses of radical prostate radiotherapy and 168 radical prostatectomies in the audit's windows, with the second lowest adjusted readmission rate in England at 4.8 percent","The city the Cambridge Prognostic Group risk table is named after; a STAMPEDE2 site"],"url":"https://www.cuh.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"ISRCTN66357938: STAMPEDE2, the successor platform trial testing stereotactic ablative radiotherapy and lutetium-177 PSMA added to standard of care in metastatic hormone-sensitive disease","url":"https://www.isrctn.com/ISRCTN66357938","date":"2026-09-25"}],"institutionName":"Addenbrooke's Hospital, Cambridge University Hospitals"},{"institutionId":"imperial-cancer-centre","name":"Charing Cross, Hammersmith and St Mary's Hospitals","trust":"Imperial College Healthcare NHS Trust","city":"London","nation":"England","offers":["233 radical prostatectomies and 250 courses of radical prostate radiotherapy in the audit's windows","Imperial College London sponsors TRANSFORM, IP7-PACIFIC and IP9-ATLAS: the screening, diagnosis and surveillance trials that between them will redraw the pathway"],"url":"https://www.imperial.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"ISRCTN13801649: TRANSFORM, trial of randomised approaches for national screening for men. Stage 1 recruitment from 21 November 2025, target 16,000; two pre-consent randomisation designs allocating men to one of four prostate health checks or to a control group; principal investigator Hashim Ahmed","url":"https://www.isrctn.com/ISRCTN13801649","date":"2025-12-30"},{"label":"ISRCTN11171089: IP7-PACIFIC, biparametric MRI and image-fusion targeted biopsy against the standard diagnostic pathway","url":"https://www.isrctn.com/ISRCTN11171089","date":"2026-09-25"}],"institutionName":"Imperial College Healthcare NHS Trust / Imperial College London Cancer Research"},{"institutionId":"birmingham-cancer-centre","name":"Queen Elizabeth Hospital Birmingham","trust":"University Hospitals Birmingham NHS Foundation Trust","city":"Birmingham","nation":"England","offers":["294 courses of radical prostate radiotherapy and 212 radical prostatectomies in the audit's windows","A PACE-B site"],"url":"https://www.uhb.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"}],"institutionName":"University Hospitals Birmingham / University of Birmingham Cancer Research Centre"},{"institutionId":"oxford-cancer","name":"Churchill Hospital","trust":"Oxford University Hospitals NHS Foundation Trust","city":"Oxford","nation":"England","offers":["327 courses of radical prostate radiotherapy and 156 radical prostatectomies in the audit's windows","A PACE-B site; the University of Oxford's Nuffield Department of Surgical Sciences, which ran ProtecT"],"url":"https://www.ouh.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"University of Oxford, Nuffield Department of Surgical Sciences: Professor Freddie Hamdy","url":"https://www.nds.ox.ac.uk/team/freddie-hamdy-cbe","date":"2026-09-25"}],"institutionName":"Oxford Cancer (Oxford University Hospitals and University of Oxford)"},{"institutionId":"bristol-haematology-oncology-centre","name":"Bristol Haematology and Oncology Centre","trust":"University Hospitals Bristol and Weston NHS Foundation Trust","city":"Bristol","nation":"England","offers":["195 courses of radical prostate radiotherapy in the audit's window","The University of Bristol coordinated ProtecT's recruitment and patient-reported outcomes work"],"url":"https://www.uhbw.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"University of Bristol research information: Professor Jenny L Donovan","url":"https://research-information.bris.ac.uk/en/persons/jenny-l-donovan","date":"2026-09-25"}],"institutionName":"Bristol Haematology and Oncology Centre"},{"institutionId":"hull-castle-hill","name":"Castle Hill Hospital and the Queen's Centre","trust":"Hull University Teaching Hospitals NHS Trust","city":"Cottingham","nation":"England","offers":["319 courses of radical prostate radiotherapy and 240 radical prostatectomies in the audit's windows","One of the first centres to publish a patient leaflet for prostate stereotactic ablative radiotherapy after the June 2026 policy"],"url":"https://www.hey.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"}],"institutionName":"Castle Hill Hospital, Hull (Queen's Centre)"},{"institutionId":"nottingham-cancer-centre","name":"Nottingham City Hospital","trust":"Nottingham University Hospitals NHS Trust","city":"Nottingham","nation":"England","offers":["348 courses of radical prostate radiotherapy and 95 radical prostatectomies in the audit's windows"],"url":"https://www.nuh.nhs.uk/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"}],"institutionName":"Nottingham University Hospitals Cancer Centre (City Hospital)"},{"institutionId":"beatson-glasgow","name":"Beatson West of Scotland Cancer Centre and Queen Elizabeth University Hospital","trust":"NHS Greater Glasgow and Clyde","city":"Glasgow","nation":"Scotland","offers":["Robotic prostatectomy for the west of Scotland at the Queen Elizabeth University Hospital, with two fellowship-trained robotic surgeons","A dedicated brachytherapy theatre suite and two high dose rate suites, listed among the Beatson's national services for Scotland","A PACE-B site. NHS Greater Glasgow and Clyde treated 42.7 percent of 241 men with prostate cancer within 62 days in the quarter to March 2026"],"url":"https://www.nhsggc.scot/","sources":[{"label":"NHS Greater Glasgow and Clyde: robotic surgery for prostate cancer restarts for patients in the west of Scotland, at the Queen Elizabeth University Hospital","url":"https://www.nhsggc.scot/robotic-surgery-for-prostate-cancer-restarts-for-patients-in-the-west-of-scotland/","date":"2026-09-25"},{"label":"Beatson West of Scotland Cancer Centre: brachytherapy, with a dedicated brachytherapy theatre suite and two high dose rate suites, listed among its national services for Scotland","url":"https://www.beatson.scot.nhs.uk/patients-and-visitors/about-cancer/treatment-therapies/brachytherapy/","date":"2026-09-25"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"}],"institutionName":"Beatson West of Scotland Cancer Centre / CRUK Scotland Institute"},{"institutionId":"edinburgh-cancer-centre","name":"Western General Hospital, Edinburgh Cancer Centre","trust":"NHS Lothian","city":"Edinburgh","nation":"Scotland","offers":["Robot-assisted radical prostatectomy for south east Scotland","A low dose rate seed brachytherapy programme of more than a thousand men, and the first high dose rate prostate brachytherapy service in Scotland, from October 2021","NHS Lothian treated 17.3 percent of 191 men with prostate cancer within 62 days in the quarter to March 2026, with a median wait of 112 days"],"url":"https://www.nhslothian.scot/","sources":[{"label":"NHS Lothian","url":"https://www.nhslothian.scot/","date":"2026-09-25"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}],"institutionName":"Edinburgh Cancer Centre / CRUK Scotland Centre"},{"institutionId":"university-hospital-wales-cardiff","name":"University Hospital of Wales","trust":"Cardiff and Vale University Health Board","city":"Cardiff","nation":"Wales","offers":["81 radical prostatectomies between April 2023 and March 2024, the largest of the five Welsh surgical centres","The first UK hospital to use a da Vinci Xi robotic system, with ten years of robotic-assisted surgery by November 2024","Sponsor of ELIPSE, the trial of radical prostatectomy with or without pelvic lymph node dissection"],"url":"https://cavuhb.nhs.wales/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Cardiff and Vale University Health Board: ten years of robotic-assisted surgery at the University Hospital of Wales, the first UK hospital to use a da Vinci Xi system","url":"https://cavuhb.nhs.wales/news/latest-news/celebrating-10-years-of-robotic-assisted-surgery-at-the-university-hospital-of-wales/","date":"2024-11-19"},{"label":"ISRCTN14434966: ELIPSE, radical prostatectomy with or without pelvic lymph node dissection in high-risk localised prostate cancer","url":"https://www.isrctn.com/ISRCTN14434966","date":"2026-09-25"}],"institutionName":"University Hospital of Wales, Cardiff"},{"institutionId":"velindre-cardiff","name":"Velindre Cancer Centre","trust":"Velindre University NHS Trust","city":"Cardiff","nation":"Wales","offers":["629 courses of radical prostate radiotherapy in the audit's window, the radiotherapy centre for south east Wales","High and low dose rate brachytherapy, stereotactic radiotherapy and molecular radiotherapy","A PACE-B site through Cardiff University"],"url":"https://velindre.nhs.wales/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Velindre University NHS Trust: Velindre Cancer Centre, which delivers intensity modulated radiotherapy, stereotactic radiotherapy, high and low dose rate brachytherapy and molecular radiotherapy for South East Wales","url":"https://velindre.nhs.wales/","date":"2026-09-25"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"}],"institutionName":"Velindre Cancer Centre"},{"institutionId":"morriston-swansea","name":"Morriston Hospital","trust":"Swansea Bay University Health Board","city":"Swansea","nation":"Wales","offers":["35 radical prostatectomies between April 2023 and March 2024, with the lowest adjusted readmission rate in Wales at 2.8 percent","A da Vinci Xi robotic system, the second in Wales"],"url":"https://sbuhb.nhs.wales/","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"Swansea Bay University Health Board","url":"https://sbuhb.nhs.wales/","date":"2026-09-25"}],"institutionName":"Morriston Hospital, Swansea"},{"institutionId":"northern-ireland-cancer-centre","name":"Belfast City Hospital and the Northern Ireland Cancer Centre","trust":"Belfast Health and Social Care Trust","city":"Belfast","nation":"Northern Ireland","offers":["The regional provider of radiotherapy, brachytherapy and chemotherapy for Northern Ireland, with 81 beds","Northern Ireland's first robotic prostatectomy service","A PACE-B site and a PACE-NODES site"],"url":"https://belfasttrust.hscni.net/services/cancer/treatments/the-northern-ireland-cancer-centre/","sources":[{"label":"Belfast Health and Social Care Trust: the Northern Ireland Cancer Centre at Belfast City Hospital, the regional provider of radiotherapy, brachytherapy and chemotherapy","url":"https://belfasttrust.hscni.net/services/cancer/treatments/the-northern-ireland-cancer-centre/","date":"2026-09-25"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"}],"institutionName":"Northern Ireland Cancer Centre, Belfast City Hospital"},{"name":"North West Cancer Centre, Altnagelvin Hospital","trust":"Western Health and Social Care Trust","city":"Londonderry","nation":"Northern Ireland","offers":["Northern Ireland's second radiotherapy centre, opened November 2016, with three linear accelerators and a catchment of around 500,000 people including north Donegal"],"url":"https://westerntrust.hscni.net/hospitals/north-west-cancer-centre/","sources":[{"label":"Western Health and Social Care Trust: the North West Cancer Centre at Altnagelvin Hospital, Londonderry, Northern Ireland's second radiotherapy centre, opened November 2016","url":"https://westerntrust.hscni.net/hospitals/north-west-cancer-centre/","date":"2026-09-25"}]}],"centresNote":{"text":"Prostate cancer is operated on in more places than most cancers and the NHS has two national volume standards for it that do not agree. NHS England's service specification 170114S, of February 2019, says there are 54 specialist urological multidisciplinary teams in England, that radical prostatectomy must be carried out in the host hospital of the specialist team, and that each specialist centre must do at least 100 cases a year with at least 25 per surgeon. Its own text excludes robot-assisted prostatectomy and points at separate guidance, which is clinical commissioning policy B14/P/a of October 2015: that one says robotic surgery is commissioned from networked centres doing at least 150 robot-assisted laparoscopic radical prostatectomies a year. The 150 figure traces back to the 2014 NICE guideline that NG131 replaced, and B14/P/a gave itself a review date of April 2017 with no successor published since. GIRFT's urology report of July 2018 proposed a third set of numbers, 20 procedures per surgeon and 40 per centre, while being openly sceptical that volume drives outcome; a later GIRFT study of more than 35,000 prostatectomies did find 30-day emergency readmission fell from 10.6 percent in trusts doing fewer than 50 a year to 7.0 percent in those doing 300 or more.\n\nThe centre cards above are built from the National Prostate Cancer Audit's own workbook rather than from any commissioning list, because the audit is the only source that names providers with numbers attached. Its fifth indicator names 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024, and its eighth names 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022. Wales is reported at health board level: Cardiff and Vale (81 operations), Aneurin Bevan (41), Betsi Cadwaladr (36), Swansea Bay (35) and Hywel Dda (11). Scotland and Northern Ireland are not in the audit, so no comparable volume figures exist for them and their cards are built from each board's or trust's own service pages and from Public Health Scotland's waiting-time workbook. The British Association of Urological Surgeons closed its radical prostatectomy data collection on 31 December 2019, so there is no current published surgeon-level or unit-level outcome data in the UK at all.\n\nTwo national changes in 2026 affect where a man would be treated. NHS England made prostate stereotactic ablative radiotherapy routinely commissioned on 15 June 2026 and expects it to be offered at all 48 English radiotherapy providers, though no list of the 48 has been published. And lutetium-177 PSMA is not commissioned anywhere in the NHS: NICE refused it (TA930) and terminated the second appraisal (TA1179), the Scottish Medicines Consortium refused it twice (SMC2517 and SMC2966), and NHS England's molecular radiotherapy service specification 2322 does not mention it, referencing only radium-223 among prostate radiopharmaceuticals. Where it is given in UK hospitals it is through a trial, an expanded access programme or privately.","sources":[{"label":"NHS England service specification 170114S: specialised kidney, bladder and prostate cancer services (adults), February 2019. There are 54 specialist urological multidisciplinary teams across England; radical prostatectomy must be carried out in the host hospital of the specialist team; each specialist centre must undertake a minimum of 100 cases a year, with a minimum of 25 cases per surgeon","url":"https://www.england.nhs.uk/wp-content/uploads/2019/02/specialised-kidney-bladder-and-prostate-cancer-services-adults.pdf","date":"2019-02"},{"label":"NHS England clinical commissioning policy B14/P/a: robotic-assisted surgical procedures for prostate cancer, October 2015. Robotic surgery is commissioned from networked centres undertaking at least 150 robot-assisted laparoscopic radical prostatectomies a year, with a recognised training programme and participation in the national audit. Its own stated review date was April 2017 and no successor policy could be found","url":"https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/10/b14pa-rbtic-asstd-srgry-prostate-cancer-oct15.pdf","date":"2015-10"},{"label":"GIRFT: urology, national specialty report (Simon Harrison, July 2018). Recommendation 15 asks that complex cancer surgery be done by surgeons performing 20 or more procedures a year in centres performing 40 or more; the report is sceptical of the volume-outcome case and records 30-day emergency readmission after radical prostatectomy ranging from 1 to 20 percent between trusts","url":"https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/07/GIRFT-Urology.pdf","date":"2018-07"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, data tables. The PI5 sheet names all 49 English surgical centres with the number of radical prostatectomies each did between 1 April 2023 and 31 March 2024; the PI8 sheet names all 48 English radiotherapy centres with their radical prostate radiotherapy numbers for 1 September 2021 to 31 August 2022","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","date":"2025-10"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"},{"label":"NHS England service specification 2322: radiotherapy services, subspecialisation in molecular radiotherapy (all ages), September 2024. It tiers providers into three levels and names no individual centre, leaving a placeholder where the commissioned provider list should be. The only prostate radiopharmaceutical it references is radium-223; lutetium-177 PSMA does not appear","url":"https://www.england.nhs.uk/wp-content/uploads/2024/09/2322-molecular-radioherapy-service-specification.pdf","date":"2024-09"},{"label":"NICE TA930: lutetium-177 vipivotide tetraxetan (Pluvicto) for PSMA-positive hormone-relapsed metastatic prostate cancer after two or more treatments, NOT recommended (15 November 2023)","url":"https://www.nice.org.uk/guidance/ta930","date":"2023-11-15"},{"label":"NICE TA1179: lutetium-177 vipivotide tetraxetan for PSMA-positive hormone-relapsed metastatic prostate cancer after an anti-androgen but not a taxane, TERMINATED 16 July 2026 because the company did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/terminated/ta1179","date":"2026-07-16"},{"label":"SMC2966: lutetium (177Lu) vipivotide tetraxetan (Pluvicto), non-submission, not recommended for use within NHSScotland for PSMA-positive metastatic castration-resistant prostate cancer after an androgen receptor pathway inhibitor (10 August 2026)","url":"https://scottishmedicines.org.uk/medicines-advice/lutetium-177lu-vipivotide-tetraxetan-pluvicto-nonsub-smc2966/","date":"2026-08-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}]},"funding":[{"line":"CPG 1 localised disease","treatment":"Active surveillance, offered rather than merely permitted; radical prostatectomy or radical radiotherapy only if surveillance is unsuitable or unacceptable","refs":["active-surveillance","prostatectomy","prostate-low-risk"],"england":{"body":"NHS England","decision":"Not a drug decision: NICE NG131 recommendation 1.3.8 says offer active surveillance in Cambridge Prognostic Group 1, and 1.3.14 sets the monitoring protocol. NICE quality standard QS91 statement 2 makes it a quality measure. The national audit's second indicator counts the CPG 1 men who get radical treatment anyway: 7 percent in England, ranging from 2 to 40 percent between specialist multidisciplinary teams","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations"},"wales":"NICE NG131 and QS91 apply; NICE quality standards apply in England and Wales. Wales's CPG 1 overtreatment rate was also 7 percent, ranging from 3 to 10 percent across four health boards.","northernIreland":"NICE guidelines are reviewed for applicability and endorsed for implementation by the Department of Health under circular HSC (SQSD) 9/26; Northern Ireland is not in the national audit, so no overtreatment rate is published.","note":"ProtecT is why this is an offer and not a compromise: at fifteen years, prostate cancer death was 3.1 percent with active monitoring, 2.2 percent with surgery and 2.9 percent with radiotherapy, and 133 of 545 men in the monitoring arm were alive with no prostate cancer treatment at all.","refNames":["Active surveillance","Radical prostatectomy","Localised prostate cancer, very low and low risk"]},{"line":"CPG 2 to 5 localised and locally advanced disease, radiotherapy","treatment":"Hypofractionated radiotherapy, 60 Gy in 20 fractions, with image-guided intensity modulated radiation therapy; six months of androgen deprivation therapy alongside it in CPG 2 to 5, with continuing for up to three years in CPG 4 and 5 offered as an option to consider","refs":["hypofractionation","adt","prostate-high-risk"],"england":{"body":"NHS England","decision":"NICE NG131 recommendations 1.3.19, 1.3.21, 1.3.22 and 1.3.23. The 60 Gy in 20 fractions schedule comes from CHHiP, a 3,216-man UK trial run from the Institute of Cancer Research. Brachytherapy with external beam radiotherapy is a consider in CPG 2 to 5 (1.3.24); brachytherapy alone is not offered in CPG 4 and 5 (1.3.25)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations"},"wales":"NICE NG131 applies. Velindre Cancer Centre delivered 629 courses of radical prostate radiotherapy in the audit's window and offers both high and low dose rate brachytherapy.","northernIreland":"NICE NG131 applies through the Department of Health. Radiotherapy is delivered at two centres, the Northern Ireland Cancer Centre in Belfast and the North West Cancer Centre at Altnagelvin.","note":"England delivered 20,782 courses of radical prostate radiotherapy in 2024, 13 percent more than in 2023.","refNames":["Hypofractionation (fewer, larger radiotherapy doses)","Androgen deprivation therapy (ADT)","Localised prostate cancer, high and very high risk"]},{"line":"Low and intermediate risk localised disease, five-fraction radiotherapy","treatment":"Stereotactic ablative radiotherapy, 36.25 Gy in five fractions over one to two weeks, for men who do not need androgen deprivation therapy","refs":["sbrt","prostate-intermediate-risk"],"england":{"body":"NHS England","decision":"Routinely commissioned from 15 June 2026 under clinical commissioning policy 2106, as an alternative to moderately hypofractionated external beam radiotherapy. Eligibility follows PACE-B: stage T1 or T2, low risk (PSA below 10 and Gleason 6) or intermediate risk (PSA 10.1 to 20 or Gleason 3+4, not 4+3), fit for radical treatment with a life expectancy of ten years or more, performance status 2 or better, and an international prostate symptom score below 20. It replaces the 2016 policy that ran prostate SABR through commissioning through evaluation","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"},"wales":"This is an NHS England commissioning policy and does not bind Wales; no equivalent all-Wales policy could be found. Velindre lists stereotactic radiotherapy among its services.","northernIreland":"An NHS England commissioning policy, so it does not apply. No equivalent Northern Ireland policy could be found.","note":"NHS England expects the treatment at all 48 English radiotherapy providers and estimates around 3,500 men a year will choose it out of roughly 17,500 diagnosed with low or intermediate risk disease. The policy requires at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance sign-off on contouring before a centre may offer it. PACE-B found 5-year freedom from failure of 95.8 percent against 94.6 percent, with late grade 2 or worse genitourinary toxicity of 26.9 percent against 18.3 percent.","refNames":["SBRT / SABR (stereotactic radiotherapy)","Localised prostate cancer, intermediate risk"]},{"line":"High-risk non-metastatic hormone-sensitive disease, starting long-term hormone therapy","treatment":"Two years of abiraterone acetate with prednisolone added to androgen deprivation therapy and radiotherapy; or six cycles of docetaxel","refs":["abiraterone","docetaxel","prostate-high-risk"],"england":{"body":"NHS England","decision":"Not a NICE appraisal. Abiraterone in this setting is an off-label use funded through NHS England clinical commissioning policy URN 2312, available from 16 January 2026 and published 21 May 2026, on the STAMPEDE eligibility criteria: non-metastatic and either node-positive, or node-negative with two or more of stage T3 or T4, Gleason 8 to 10 and a PSA of 40 nanograms per millilitre or more, or relapsing with a PSA of 4 or more doubling in under six months, or a PSA of 20 or more. Treatment stops at two years. NICE NG131 recommendation 1.3.26 separately asks teams to discuss six cycles of docetaxel with the same population and make a shared decision","url":"https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","date":"2026-05-21"},"scotland":{"body":"SMC","decision":"No Scottish Medicines Consortium advice exists for abiraterone in non-metastatic hormone-sensitive disease; it is an off-label use with no submission","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=prostate","date":"2026-09-25"},"wales":"Wales got here first. One Wales decision OW20 made abiraterone with prednisolone available in NHS Wales for non-metastatic and locally advanced high-risk hormone-sensitive prostate cancer in November 2022, more than three years before England, on the same STAMPEDE criteria, with continuation beyond two and a half years by individual patient funding request.","northernIreland":"An NHS England commissioning policy, so it does not apply; no Northern Ireland equivalent could be found.","note":"The evidence is the STAMPEDE meta-analysis of two comparisons in 1,974 men: metastasis-free survival hazard ratio 0.53 and overall survival hazard ratio 0.60, with six-year metastasis-free survival of 82 percent against 69 percent. Adding enzalutamide gave no extra benefit and more toxicity. This row is the clearest case in British oncology of a trial result reaching patients through commissioning rather than appraisal, because abiraterone went generic and no company had a reason to file.","refNames":["Abiraterone acetate","Docetaxel","Localised prostate cancer, high and very high risk"]},{"line":"Newly diagnosed hormone-sensitive metastatic disease","treatment":"Androgen deprivation therapy plus one of abiraterone with prednisolone, enzalutamide, apalutamide, darolutamide, or docetaxel; darolutamide with docetaxel where both are given","refs":["abiraterone","enzalutamide","apalutamide","darolutamide","docetaxel","prostate-mhspc"],"england":{"body":"NICE","decision":"Abiraterone with androgen deprivation therapy and prednisolone or prednisone can be used for newly diagnosed high-risk hormone-sensitive metastatic disease, a cost comparison that updates and replaces TA721 and must be funded within 30 days of publication","ref":"TA1110","date":"2025-11-19","url":"https://www.nice.org.uk/guidance/ta1110"},"scotland":{"body":"SMC","decision":"Abiraterone acetate accepted for newly diagnosed high-risk metastatic hormone-sensitive prostate cancer with androgen deprivation therapy, after a Patient and Clinician Engagement meeting, nineteen months before the first English appraisal, TA721, which refused it, and nearly six years before NICE recommended it in TA1110","ref":"SMC2215","date":"2020-01-13","url":"https://scottishmedicines.org.uk/medicines-advice/abiraterone-acetate-zytiga-full-smc2215/"},"wales":"NICE appraisals apply in Wales, and health boards are required to fund a NICE-recommended medicine within two months of the first publication of the final appraisal determination under the new treatment fund directions, WHC/2017/001. The All Wales Medicines Strategy Group's own 2014 advice on abiraterone is marked superseded by the NICE appraisal.","northernIreland":"TA1110 was endorsed for implementation in Northern Ireland in December 2025. NICE technology appraisals do not apply automatically: they are reviewed for legal, policy and financial consequences, usually within four weeks of final publication, and may be endorsed with caveats.","note":"The other options in this setting each have their own appraisal: enzalutamide with androgen deprivation therapy (TA712, 7 July 2021), apalutamide with androgen deprivation therapy only where docetaxel is not suitable (TA741, 28 October 2021), darolutamide with docetaxel (TA903, 21 June 2023) and darolutamide with androgen deprivation therapy alone where docetaxel is not suitable (TA1109, 12 November 2025). Upfront docetaxel came from STAMPEDE and was commissioned by policy statement in January 2016, without an appraisal.","refNames":["Abiraterone acetate","Enzalutamide","Apalutamide","Darolutamide","Docetaxel","Metastatic hormone-sensitive prostate cancer"]},{"line":"Hormone-sensitive metastatic disease where docetaxel is not suitable: the one place the four nations differ on a current drug","treatment":"Darolutamide with androgen deprivation therapy","refs":["darolutamide","prostate-mhspc"],"england":{"body":"NICE","decision":"Can be used, only if docetaxel is not suitable and the company provides it under the commercial arrangement; recommendation 1.2 says use the least expensive of the suitable treatments, including darolutamide and apalutamide","ref":"TA1109","date":"2025-11-12","url":"https://www.nice.org.uk/guidance/ta1109"},"scotland":{"body":"SMC","decision":"NOT recommended for use within NHSScotland. This was a non-submission: Bayer did not make a submission to the Scottish Medicines Consortium for this indication","ref":"SMC2940","date":"2026-06-08","url":"https://scottishmedicines.org.uk/medicines-advice/darolutamide-nubeqa-nonsub-smc2940/"},"wales":"TA1109 applies, so Wales funds it; health boards had two months from the final appraisal determination.","northernIreland":"TA1109 was endorsed for implementation in Northern Ireland in November 2025.","note":"Scotland still funds darolutamide with docetaxel in the same disease (SMC2604, 9 October 2023) and darolutamide for non-metastatic hormone-relapsed disease (SMC2297, 9 November 2020). What it does not fund is darolutamide with androgen deprivation therapy alone, because no one asked.","refNames":["Darolutamide","Metastatic hormone-sensitive prostate cancer"]},{"line":"Non-metastatic hormone-relapsed disease at high risk of metastasis","treatment":"Apalutamide or darolutamide with androgen deprivation therapy; enzalutamide is not funded in this setting anywhere in the UK","refs":["apalutamide","darolutamide","enzalutamide","prostate-nmcrpc"],"england":{"body":"NICE","decision":"Apalutamide with androgen deprivation therapy recommended, with high risk defined as a PSA that has doubled in 10 months or less on continuous androgen deprivation therapy. Darolutamide with androgen deprivation therapy is recommended in the same setting (TA660, 25 November 2020). Enzalutamide was NOT recommended for it (TA580, 15 May 2019) because the cost-effectiveness estimates were outside the range NICE accepts","ref":"TA740","date":"2021-10-28","url":"https://www.nice.org.uk/guidance/ta740"},"scotland":{"body":"SMC","decision":"Apalutamide accepted for non-metastatic castration-resistant prostate cancer at high risk of metastasis; darolutamide accepted in the same setting (SMC2297, 9 November 2020), a fortnight before NICE. Enzalutamide NOT recommended (SMC2195, 7 October 2019)","ref":"SMC2579","date":"2023-07-10","url":"https://scottishmedicines.org.uk/medicines-advice/apalutamide-erleada-abbreviated-smc2579/"},"wales":"TA740 and TA660 apply; enzalutamide is not available in this setting.","northernIreland":"TA740 and TA660 apply through the Department of Health's endorsement process.","note":"This is the clearest example on the page of how an appraisal decision, not a clinical one, decides what a man is offered: three drugs of the same class in the same setting, two funded and one refused, in both England and Scotland. NICE separately terminated the appraisal of enzalutamide for non-metastatic disease after prostatectomy or radiotherapy (TA994, 8 August 2024) because Astellas did not submit evidence, and Scotland refused the same indication as a non-submission (SMC2742, 11 November 2024).","refNames":["Apalutamide","Darolutamide","Enzalutamide","Non-metastatic castration-resistant prostate cancer"]},{"line":"Untreated hormone-relapsed metastatic disease","treatment":"Abiraterone with prednisone or prednisolone, or enzalutamide; olaparib with abiraterone, or talazoparib with enzalutamide, where chemotherapy is not indicated","refs":["abiraterone","enzalutamide","olaparib","talazoparib","prostate-mcrpc"],"england":{"body":"NICE","decision":"Olaparib with abiraterone and prednisone or prednisolone recommended for untreated hormone-relapsed metastatic prostate cancer in people who cannot have or do not want chemotherapy. Talazoparib with enzalutamide can be used in the same setting, but only when chemotherapy is not clinically indicated and abiraterone with prednisolone is not tolerated or is precluded (TA1130, 11 February 2026). Abiraterone before chemotherapy is TA387 and enzalutamide before chemotherapy is TA377, both from 2016","ref":"TA951","date":"2024-02-07","url":"https://www.nice.org.uk/guidance/ta951"},"scotland":{"body":"SMC","decision":"Olaparib with abiraterone accepted after a Patient and Clinician Engagement meeting; talazoparib with enzalutamide accepted on an abbreviated submission on 10 March 2025 (SMC2753), eleven months before the English appraisal","ref":"SMC2617","date":"2024-03-11","url":"https://scottishmedicines.org.uk/medicines-advice/olaparib-lynparza-mcrpc-full-smc2617/"},"wales":"TA951, TA1130, TA387 and TA377 apply, with the two-month funding requirement.","northernIreland":"TA951 was endorsed in the 2023/24 list; TA1130 was endorsed in March 2026.","note":"Niraparib with abiraterone (Akeega) is available in neither nation: NICE terminated its appraisal on 22 January 2025 because Johnson and Johnson Innovative Medicine did not provide an evidence submission (TA1032), and the Scottish Medicines Consortium refused it as a non-submission on 8 June 2026 (SMC2942).","refNames":["Abiraterone acetate","Enzalutamide","Olaparib","Talazoparib","Metastatic castration-resistant prostate cancer"]},{"line":"Hormone-relapsed metastatic disease with a BRCA1 or BRCA2 mutation, after a newer hormonal treatment","treatment":"Olaparib","refs":["olaparib","parp-inhibitor","germline-testing","prostate-mcrpc"],"england":{"body":"NICE","decision":"Olaparib recommended within its marketing authorisation for hormone-relapsed metastatic prostate cancer with BRCA1 or BRCA2 mutations that has progressed after a newer hormonal treatment such as abiraterone or enzalutamide. It replaces TA831","ref":"TA887","date":"2023-05-10","url":"https://www.nice.org.uk/guidance/ta887"},"scotland":{"body":"SMC","decision":"Olaparib monotherapy accepted for BRCA1/2-mutated metastatic castration-resistant prostate cancer that has progressed after a new hormonal agent, a year before the first English appraisal (TA831, 5 October 2022) and a year and a half before TA887, which replaced it","ref":"SMC2366","date":"2021-10-11","url":"https://scottishmedicines.org.uk/medicines-advice/olaparib-lynparza-full-smc2366/"},"wales":"TA887 applies.","northernIreland":"TA887 was endorsed in the 2023/24 list.","note":"This is the row the genomic test directory exists to serve: somatic testing through M218.1 first, germline R444.2 only if the tissue test fails. Two Blueteq forms exist in England, OLAP7 and OLAP8, splitting men who have had docetaxel from those who have not.","refNames":["Olaparib","PARP inhibitors","Germline (hereditary) testing","Metastatic castration-resistant prostate cancer"]},{"line":"Untreated hormone-relapsed metastatic disease where abiraterone cannot be used","treatment":"Talazoparib with enzalutamide","refs":["talazoparib","enzalutamide","parp-inhibitor","prostate-mcrpc"],"england":{"body":"NICE","decision":"Can be used, only when chemotherapy is not clinically indicated and abiraterone with prednisolone is either not tolerated or precluded by a clinical condition, and the companies provide the drugs under their commercial arrangements. It must be funded in England within 90 days of publication. The company asked for the narrower population rather than the whole licence","ref":"TA1130","date":"2026-02-11","url":"https://www.nice.org.uk/guidance/ta1130"},"scotland":{"body":"SMC","decision":"Accepted on an abbreviated submission for metastatic castration-resistant prostate cancer with enzalutamide where chemotherapy is not clinically indicated, eleven months before the English appraisal","ref":"SMC2753","date":"2025-03-10","url":"https://scottishmedicines.org.uk/medicines-advice/talazoparib-talzenna-abb-smc2753/"},"wales":"TA1130 applies, with the two-month funding requirement under the new treatment fund directions.","northernIreland":"TA1130 was endorsed for implementation in Northern Ireland in March 2026.","note":"Blueteq form TAL2 in England, with baseline funding from 13 May 2026. Note the restriction: Scotland accepted the wider licensed population and NICE recommended only the subgroup who cannot have abiraterone, so the same two drugs open to a different set of men on either side of the border.","refNames":["Talazoparib","Enzalutamide","PARP inhibitors","Metastatic castration-resistant prostate cancer"]},{"line":"Hormone-relapsed metastatic disease, after docetaxel","treatment":"Abiraterone, enzalutamide or cabazitaxel","refs":["abiraterone","enzalutamide","cabazitaxel","prostate-mcrpc"],"england":{"body":"NICE","decision":"Cabazitaxel with prednisone or prednisolone recommended only where the performance status is 0 or 1 and the man has already had 225 mg per square metre or more of docetaxel, stopping at progression or at ten cycles. Abiraterone after one docetaxel-containing regimen is TA259 (27 June 2012) and enzalutamide after docetaxel is TA316 (23 July 2014); docetaxel itself is TA101, recommended only at a Karnofsky performance status of 60 percent or more","ref":"TA391","date":"2016-05-25","url":"https://www.nice.org.uk/guidance/ta391"},"scotland":{"body":"SMC","decision":"Cabazitaxel accepted for restricted use after a Patient and Clinician Engagement meeting, restricted to men who have had at least 225 mg per square metre of docetaxel with a performance status of 0 or 1","date":"2016-12-12","url":"https://scottishmedicines.org.uk/medicines-advice/cabazitaxel-jevtana-resubmission-73511/"},"wales":"TA391, TA259 and TA316 apply. The All Wales Medicines Strategy Group's 2011 cabazitaxel advice is marked excluded from appraisal because NICE appraised the medicine.","northernIreland":"TA391, TA259 and TA316 apply through the Department of Health.","note":"NICE's wording throughout is hormone-relapsed rather than castration-resistant; the two mean the same thing.","refNames":["Abiraterone acetate","Enzalutamide","Cabazitaxel","Metastatic castration-resistant prostate cancer"]},{"line":"Bone metastases, symptomatic, with no known visceral metastases","treatment":"Radium-223 dichloride","refs":["radium-223","prostate-mcrpc"],"england":{"body":"NICE","decision":"Radium-223 dichloride recommended only if the man has already had docetaxel, or docetaxel is contraindicated or unsuitable, with the patient access scheme discount. This appraisal replaced TA376 after a Cancer Drugs Fund reconsideration; radium-223 has since moved to baseline commissioning","ref":"TA412","date":"2016-09-28","url":"https://www.nice.org.uk/guidance/ta412"},"scotland":{"body":"SMC","decision":"Radium-223 accepted for castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastases, with a note added after the September 2018 licence restriction to men who have had two prior lines","date":"2015-10-12","url":"https://scottishmedicines.org.uk/medicines-advice/radium-223-xofigo-fullsubmission-107715/"},"wales":"TA412 applies.","northernIreland":"TA412 applies through the Department of Health.","note":"Zoledronic acid is a separate NG131 recommendation (1.5.19) for preventing skeletal-related events, not an appraisal.","refNames":["Radium-223 dichloride","Metastatic castration-resistant prostate cancer"]},{"line":"PSMA-positive hormone-relapsed metastatic disease: the drug no UK nation funds","treatment":"Lutetium-177 vipivotide tetraxetan (Pluvicto)","refs":["pluvicto","psma-pet","prostate-mcrpc"],"england":{"body":"NICE","decision":"NOT recommended within its marketing authorisation, either after taxane chemotherapy and an anti-androgen or where taxanes are medically unsuitable. The committee noted that no evidence was submitted comparing it with radium-223. The second appraisal, covering use after an anti-androgen but before a taxane, was terminated on 16 July 2026 because the company did not provide an evidence submission (TA1179)","ref":"TA930","date":"2023-11-15","url":"https://www.nice.org.uk/guidance/ta930"},"scotland":{"body":"SMC","decision":"NOT recommended for use within NHSScotland, twice: first after a full submission with a Patient and Clinician Engagement meeting in October 2023 (SMC2517), then as a non-submission for the pre-taxane indication on 10 August 2026","ref":"SMC2966","date":"2026-08-10","url":"https://scottishmedicines.org.uk/medicines-advice/lutetium-177lu-vipivotide-tetraxetan-pluvicto-nonsub-smc2966/"},"wales":"TA930 applies, so it is not funded in Wales either. No One Wales decision covers it.","northernIreland":"TA930 was endorsed for implementation in Northern Ireland in the 2023/24 list. Northern Ireland endorses negative appraisals as well as positive ones.","note":"NHS England's molecular radiotherapy service specification 2322 of September 2024 does not mention lutetium-177 PSMA at all; the only lutetium in it is lutetium oxodotreotide for neuroendocrine tumours, and the only prostate radiopharmaceutical is radium-223. Where men in the UK receive it, it is through a trial such as STAMPEDE2, through a company expanded access programme, or privately.","refNames":["Lutetium-177 vipivotide tetraxetan","PSMA PET","Metastatic castration-resistant prostate cancer"]},{"line":"Androgen deprivation therapy itself","treatment":"Gonadotrophin-releasing hormone agonists (not appraised), degarelix, or relugolix taken by mouth","refs":["adt","degarelix","relugolix"],"england":{"body":"NICE","decision":"Relugolix recommended for advanced hormone-sensitive prostate cancer, alongside radiotherapy for high-risk localised and locally advanced disease, and as neoadjuvant treatment before radiotherapy. Degarelix is recommended only for people with spinal metastases, and only if the commissioner can achieve at least the June 2016 discounted cost (TA404)","ref":"TA995","date":"2024-08-14","url":"https://www.nice.org.uk/guidance/ta995"},"scotland":{"body":"SMC","decision":"Relugolix accepted for the same three indications; degarelix accepted on an abbreviated submission for high-risk localised and locally advanced disease with radiotherapy (SMC2625, 11 December 2023) and earlier for advanced hormone-dependent disease (560/09)","ref":"SMC2678","date":"2024-10-07","url":"https://scottishmedicines.org.uk/medicines-advice/relugolix-orgovyx-full-smc2678/"},"wales":"TA995 and TA404 apply. The All Wales advice on degarelix is marked superseded by the NICE appraisal.","northernIreland":"TA995 was endorsed in the 2024/25 list.","note":"The gonadotrophin-releasing hormone agonists that most men actually take were never appraised: they are generic, funded through national chemotherapy and primary care arrangements, and NG131 recommends bilateral orchidectomy as an alternative to continuous agonist therapy (1.5.7). Relugolix matters because it is a tablet: no injection, and testosterone recovers faster.","refNames":["Androgen deprivation therapy (ADT)","Degarelix","Relugolix"]},{"line":"Focal and ablative treatment of localised disease","treatment":"High-intensity focused ultrasound, cryotherapy, padeliporfin photodynamic therapy, irreversible electroporation","refs":["prostate-low-risk","prostatectomy"],"england":{"body":"NICE","decision":"Padeliporfin (Tookad) NOT recommended for untreated, unilateral, low-risk prostate cancer. NG131 recommendation 1.3.28 says do not offer high-intensity focused ultrasound or cryotherapy for localised disease outside controlled clinical trials comparing them with established interventions, and 1.3.34 says the same for locally advanced disease. Focal high-intensity focused ultrasound and focal cryoablation have HealthTech guidance finding no major safety concerns but limited evidence on efficacy","ref":"TA546","date":"2018-11-21","url":"https://www.nice.org.uk/guidance/ta546"},"scotland":{"body":"SMC","decision":"No Scottish Medicines Consortium advice exists for padeliporfin in prostate cancer","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=prostate","date":"2026-09-25"},"wales":"TA546 applies and NG131's position on focal therapy holds.","northernIreland":"TA546 applies through the Department of Health.","note":"This is moving. The government committed up to 2.8 million pounds of capital funding for focal therapies on 2 June 2026, alongside the screening decision, explicitly to develop the evidence base; NICE's 2025 review of NG131 named the localised and locally advanced section for update, with publication expected 17 December 2027. Sipuleucel-T, the only prostate cancer vaccine NICE ever appraised, was withdrawn in 2015 after its marketing authorisation was withdrawn (TA332).","refNames":["Localised prostate cancer, very low and low risk","Radical prostatectomy"]}],"fundingNote":{"text":"Thirty NICE technology appraisal numbers mention prostate cancer. Nineteen are current recommendations, three are outright refusals (padeliporfin TA546, enzalutamide for non-metastatic hormone-relapsed disease TA580, and lutetium-177 vipivotide tetraxetan TA930), three are terminated because a company did not submit evidence (enzalutamide TA994, niraparib with abiraterone TA1032 and the second lutetium-177 appraisal TA1179) and five have been withdrawn or replaced, including sipuleucel-T (TA332), withdrawn in 2015 after its marketing authorisation was withdrawn on 19 May 2015.\n\nThe Cancer Drugs Fund does not currently carry a single prostate indication. Version 1.408 of the national list, updated 24 September 2026 and read in full, has 29 entries in section A, the managed access fund itself, and none of them is a prostate drug; every prostate row is in section B, routinely commissioned since 1 April 2016, with its own Blueteq form. Four of those rows were once Cancer Drugs Fund drugs and have since transitioned to baseline: abiraterone before and after chemotherapy, enzalutamide before chemotherapy, and radium-223.\n\nTwo England rows bypass NICE entirely and both matter. Blueteq form ABI4, funded from 13 December 2024 under a commissioning policy proposition, covers abiraterone with androgen deprivation therapy for newly diagnosed high-risk metastatic disease where a man fit for docetaxel chooses abiraterone instead; it predates TA1110 by eleven months. Blueteq form ABI5, funded from 16 January 2026 under clinical commissioning policy URN 2312, covers abiraterone for high-risk hormone-sensitive non-metastatic disease, an off-label use with no appraisal at all, carrying STAMPEDE's exact eligibility criteria and a two-year stop. Both list forms carry an explicit exception for men who entered STAMPEDE and are still benefiting, so that trial closure does not take the drug away.\n\nScotland has 25 prostate advices. It diverges from England in one live place, darolutamide with androgen deprivation therapy in hormone-sensitive metastatic disease, which England funds under TA1109 and Scotland refused on 8 June 2026 because Bayer made no submission. Elsewhere it has often been earlier: abiraterone in metastatic hormone-sensitive disease by nineteen months on the first English appraisal, TA721, which refused it, and by nearly six years on TA1110, which recommended it; olaparib for BRCA-mutated disease by a year on TA831 and a year and a half on TA887, which replaced it; talazoparib with enzalutamide by eleven months; darolutamide for non-metastatic hormone-relapsed disease by a fortnight. It agrees with England on every refusal.\n\nWales follows NICE, and the new treatment fund directions of 2017 require health boards to fund a NICE-recommended medicine within two months of the first publication of the final appraisal determination. Its four All Wales appraisals on prostate medicines are all marked superseded or excluded because NICE has since appraised the same indication. But Wales has one genuine divergence and it ran the other way: One Wales decision OW20, from November 2022, made abiraterone available for high-risk hormone-sensitive non-metastatic disease more than three years before England's equivalent policy. Northern Ireland does not apply NICE appraisals automatically: under circular HSC (SQSD) 12/22 each is reviewed for legal, policy and financial consequences, usually within four weeks of publication, may be endorsed with caveats, and trusts are expected to plan implementation within three months of the service notification and complete it within a further six. Negative appraisals are endorsed too: TA930 appears in the 2023/24 list.","sources":[{"label":"NICE: all products on prostate cancer (79 products on the check date). The same address with a status filter answered an error page","url":"https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/prostate-cancer/products","date":"2026-09-25"},{"label":"NHS England: national Cancer Drugs Fund list, version 1.408 of 24 September 2026, read in full. Section A is the Cancer Drugs Fund proper and contains no prostate indication; every prostate row sits in section B, routinely commissioned, with its Blueteq form reference","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"NHS England: national Cancer Drugs Fund list, publication page","url":"https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/","date":"2026-09-24"},{"label":"NICE TA930: lutetium-177 vipivotide tetraxetan (Pluvicto) for PSMA-positive hormone-relapsed metastatic prostate cancer after two or more treatments, NOT recommended (15 November 2023)","url":"https://www.nice.org.uk/guidance/ta930","date":"2023-11-15"},{"label":"NICE TA1179: lutetium-177 vipivotide tetraxetan for PSMA-positive hormone-relapsed metastatic prostate cancer after an anti-androgen but not a taxane, TERMINATED 16 July 2026 because the company did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/terminated/ta1179","date":"2026-07-16"},{"label":"NICE TA1032: niraparib with abiraterone acetate and prednisone for untreated hormone-relapsed metastatic prostate cancer, TERMINATED 22 January 2025 because Johnson and Johnson Innovative Medicine did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/terminated/ta1032","date":"2025-01-22"},{"label":"NICE TA994: enzalutamide for non-metastatic prostate cancer after radical prostatectomy or radiotherapy, TERMINATED 8 August 2024 because Astellas Pharma did not provide an evidence submission","url":"https://www.nice.org.uk/guidance/terminated/ta994","date":"2024-08-08"},{"label":"NICE TA332: sipuleucel-T for asymptomatic or minimally symptomatic metastatic hormone-relapsed prostate cancer (23 February 2015), withdrawn because the marketing authorisation for sipuleucel-T was withdrawn on 19 May 2015","url":"https://www.nice.org.uk/guidance/ta332","date":"2015-02-23"},{"label":"NHS England clinical commissioning policy 2312: abiraterone acetate and prednisolone for high-risk, hormone-sensitive, non-metastatic prostate cancer in adults (published 21 May 2026, funded from 16 January 2026). Routine commissioning of an off-label use, for two years, on the STAMPEDE eligibility criteria","url":"https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","date":"2026-05-21"},{"label":"Scottish Medicines Consortium: medicines advice, keyword search for prostate (the site's own search parameter; the medicines-advice index without it returns the most recent advice only)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=prostate","date":"2026-09-25"},{"label":"All Wales Therapeutics and Toxicology Centre: One Wales decision OW20, abiraterone with prednisolone for non-metastatic and locally advanced high-risk hormone-sensitive prostate cancer, an off-label use with no NICE appraisal. Original decision November 2022, last reviewed April 2024, restricted to newly diagnosed high-risk disease with node-positive disease or two or more of stage T3 or T4, Gleason 8 to 10 and PSA of 40 nanograms per millilitre or more","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/abiraterone-for-hormone-sensitive-prostate-cancer/","date":"2024-04"},{"label":"Welsh Government: new treatment fund, directions on implementation timescales, WHC/2017/001 (21 April 2017). Health boards must make medicines recommended by NICE and the All Wales Medicines Strategy Group available within two months of the first publication of the final appraisal determination, with a three-month timescale only in exceptional circumstances notified to the Chief Medical Officer","url":"https://www.gov.wales/new-treatment-fund-directions-implementation-timescales-whc2017001","date":"2017-04-21"},{"label":"Northern Ireland Department of Health: circular HSC (SQSD) 12/22, NICE technology appraisals, process for endorsement, implementation, monitoring and assurance in Northern Ireland (1 April 2022). NICE guidance does not apply automatically: it is reviewed for applicability, may be endorsed with caveats, and trusts are expected to plan implementation within three months of the service notification and to complete it within a further six","url":"https://www.health-ni.gov.uk/publications/circular-hsc-sqsd-12-22-nice-technology-appraisals-process-endorsement-implementation-monitoring-and-assurance-northern-ireland","date":"2022-04-01"},{"label":"Northern Ireland Department of Health: circular HSC (SQSD) 9/26, NICE guidelines process for endorsement, implementation, monitoring and assurance in Northern Ireland (31 July 2026)","url":"https://www.health-ni.gov.uk/publications/circular-hsc-sqsd-9-26-nice-guidelines-process-endorsement-implementation-monitoring-and-assurance-northern-ireland","date":"2026-07-31"}]},"tests":[{"target":"PSA (prostate-specific antigen) in blood","code":"not in the genomic directory: a biochemistry test","test":"A blood test, with age-specific thresholds for men who have symptoms and no national threshold at all for men who do not","opens":"The whole pathway. Above the NG12 table 2 threshold for your age, with symptoms, a GP may refer you on a suspected cancer pathway; a malignant-feeling prostate on examination is a referral regardless of the PSA","how":"NICE NG12 recommendation 1.6.2 says consider a PSA and a digital rectal examination in anyone with lower urinary tract symptoms, erectile dysfunction or visible blood in the urine. Table 2 gives the thresholds in micrograms per litre: more than 2.5 at 40 to 49, 3.5 at 50 to 59, 4.5 at 60 to 69, 6.5 at 70 to 79, clinical judgement below 40 and above 79. If you have no symptoms there is no NICE threshold: you can ask a GP for the test, and the NHS page says routine PSA testing is not offered unless genetic testing has found a faulty BRCA2 gene. Prepare properly or the number will be wrong: no anal sex, no ejaculation and no vigorous exercise such as cycling for 48 hours, and wait four to six weeks after a urine infection has cleared. NG131 recommendation 1.2.6 adds the rule that protects you from the test: do not automatically offer a biopsy on the PSA alone","sources":[{"label":"NICE NG12: suspected cancer, recommendations organised by site of cancer (prostate is 1.6.1 to 1.6.3 with the age-specific PSA thresholds in table 2). Published 23 June 2015, last updated 15 April 2026","url":"https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","date":"2026-04-15"},{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"}]},{"target":"Multiparametric MRI of the prostate, reported on a Likert scale","code":"imaging, not in the genomic directory","test":"A scan combining T2-weighted, diffusion-weighted and dynamic contrast-enhanced sequences, reported by a radiologist as a single score from 1 to 5","opens":"A targeted biopsy at Likert 3 or more; a shared decision about whether to have a biopsy at all at Likert 1 or 2","how":"NICE NG131 recommendation 1.2.2 makes this the first-line investigation for suspected clinically localised prostate cancer and asks for a five-point Likert score, not a PI-RADS category. Recommendation 1.2.3 offers an MRI-influenced biopsy at Likert 3 or more; 1.2.4 says consider omitting biopsy at Likert 1 or 2 after discussing the risks and benefits. Recommendation 1.2.1 sets the limit: do not routinely offer MRI to someone who could not have radical treatment. If you are on active surveillance and have never had an MRI, recommendation 1.3.13 says you should be offered one. MRI fusion biopsy systems are a separate question and NICE HTG678 does not recommend them for routine adoption","sources":[{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE HTG678 (formerly DG53): MRI fusion biopsy systems for diagnosing prostate cancer (24 May 2023). There is not enough evidence to recommend routine adoption; centres already using them may continue but are asked to collect data","url":"https://www.nice.org.uk/guidance/htg678","date":"2023-05-24"},{"label":"Ahmed HU and others. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-822 (PMID 28110982)","url":"https://europepmc.org/article/MED/28110982","date":"2017-02-25"}]},{"target":"The biopsy, and which route it takes","code":"pathology, not in the genomic directory","test":"Local anaesthetic transperineal biopsy with a freehand needle positioning device, or transrectal ultrasound-guided biopsy","opens":"A Gleason score and grade group, which with the PSA and the stage gives the Cambridge Prognostic Group, which decides what is offered","how":"Ask which route your centre uses. NICE HTG680 recommends local anaesthetic transperineal biopsy using PrecisionPoint, and three other freehand devices with less evidence behind them, because cancer detection is no different but infection and sepsis are less common; it does not recommend the CamPROBE double freehand device. NG131 itself makes no recommendation between the two routes, and says its own harm figures come from studies that used the transrectal route. Those figures are worth having before you consent: sepsis in a little under 1 in 100, pain in 44 in 100, fever in 20 in 100, blood in the urine in 66 in 100 and blood in the semen in 90 in 100, lasting more than two weeks in 60 of them. Mapping template biopsy, sampling 20 sites, is not offered as part of an initial assessment (1.2.5) but is supported after a negative or equivocal biopsy (HTG237)","sources":[{"label":"NICE HTG680 (formerly DG54): transperineal biopsy for diagnosing prostate cancer (1 June 2023). Local anaesthetic transperineal biopsy with the PrecisionPoint freehand device is recommended, with three other freehand devices, and centres are asked to join the TRANSLATE randomised comparison with transrectal biopsy","url":"https://www.nice.org.uk/guidance/htg680","date":"2023-06-01"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE HTG237 (formerly IPG364): transperineal template biopsy and mapping of the prostate (27 October 2010). Increased diagnostic yield after a negative or equivocal biopsy; use as a mapping technique for focal therapy or inside active surveillance needs special arrangements","url":"https://www.nice.org.uk/guidance/htg237","date":"2010-10-27"}]},{"target":"BRCA1 and BRCA2 in the tumour, for a PARP inhibitor","code":"M218.1","test":"Multi-target next-generation sequencing panel for small variants in BRCA1 and BRCA2, run on the tumour tissue through a Genomic Laboratory Hub","opens":"Olaparib after a newer hormonal treatment (TA887), olaparib with abiraterone in untreated hormone-relapsed disease (TA951) and talazoparib with enzalutamide (TA1130)","how":"Ask for it when hormone-relapsed metastatic disease is confirmed, not at progression. Version 16 of the National Genomic Test Directory for cancer, of 16 July 2026, lists clinical indication M218 for prostate cancer with this as its first test. Its eligibility wording sets the order explicitly: somatic analysis should be performed first, and germline analysis under R444.2 only if there is insufficient tissue or the somatic analysis has failed. The panel also carries the standard clinical-trials reporting list, so an oncogenic ATM, CDK12, PALB2, RAD51C or RAD51D result may be reported if the laboratory's panel covers it","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (clinical indication M218, prostate cancer, with tests M218.1, M218.2 and M218.3)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NICE TA887: olaparib for hormone-relapsed metastatic prostate cancer with BRCA1 or BRCA2 mutations that has progressed after a newer hormonal treatment (10 May 2023)","url":"https://www.nice.org.uk/guidance/ta887","date":"2023-05-10"},{"label":"NICE TA951: olaparib with abiraterone and prednisone or prednisolone for untreated hormone-relapsed metastatic prostate cancer in people who cannot have or do not want chemotherapy (7 February 2024)","url":"https://www.nice.org.uk/guidance/ta951","date":"2024-02-07"},{"label":"NICE TA1130: talazoparib with enzalutamide for untreated hormone-relapsed metastatic prostate cancer (11 February 2026), only when chemotherapy is not clinically indicated and abiraterone with prednisolone is not tolerated or precluded","url":"https://www.nice.org.uk/guidance/ta1130","date":"2026-02-11"}]},{"target":"Germline BRCA1 and BRCA2, when the tumour test cannot be done","code":"R444.2","test":"Small germline panel for BRCA1 and BRCA2 small variants and copy number changes, from blood or saliva","opens":"The same PARP inhibitor decisions, and it tells your relatives something","how":"The eligibility criterion is narrow and exact: metastatic, castration-resistant prostate cancer where somatic tumour testing under M218.1 has failed. The scope gate above it says R444 applies only to patients who do not meet the R208 or R430 criteria and who have a current cancer diagnosis, for treatment decisions. If you meet the family-history criteria instead, the right code is R430, not this one","sources":[{"label":"NHS England: National Genomic Test Directory for rare and inherited disease, version 9 of 8 April 2026 (R430 inherited prostate cancer and R444.2, the prostate arm of the PARP inhibitor indication)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-04-08"},{"label":"NHS England: rare and inherited disease eligibility criteria, version 9.1 of 20 May 2026 (the R430 testing criteria: prostate cancer under 50, Ashkenazi Jewish ancestry at any age, a grandparent from Whalsay at any age, metastatic disease under 60, or a CanRisk score above 10 percent)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","date":"2026-05-20"}]},{"target":"Inherited prostate cancer, the family-history route","code":"R430.1","test":"A small germline panel covering small variants and copy number changes across eight genes: ATM, BRCA1, BRCA2, CHEK2, MLH1, MSH2, MSH6 and PALB2","opens":"From 2027 in England, a BRCA2 result with a relevant family history opens the NHS's first prostate screening programme: a PSA test every two years from 45 to 61. It also opens cascade testing for relatives","how":"Requesting specialties are clinical genetics, oncology and urology, and the directory says the test belongs at presentation rather than at progression. The criteria in version 9.1 of the eligibility document are: prostate cancer diagnosed under 50; Ashkenazi Jewish ancestry with prostate cancer at any age; at least one grandparent from Whalsay in Shetland with prostate cancer at any age; metastatic prostate cancer diagnosed under 60; or prostate cancer with a CanRisk score above 10 percent where the R208, R207 and R210 criteria are not met. Note that this is an eight-gene panel, not a BRCA-only one, and that the screening recommendation rests on BRCA2 alone","sources":[{"label":"NHS England: National Genomic Test Directory for rare and inherited disease, version 9 of 8 April 2026 (R430 inherited prostate cancer and R444.2, the prostate arm of the PARP inhibitor indication)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-04-08"},{"label":"NHS England: rare and inherited disease eligibility criteria, version 9.1 of 20 May 2026 (the R430 testing criteria: prostate cancer under 50, Ashkenazi Jewish ancestry at any age, a grandparent from Whalsay at any age, metastatic disease under 60, or a CanRisk score above 10 percent)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","date":"2026-05-20"},{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"},{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"}]},{"target":"TMPRSS2-ERG and the NTRK fusions, when the diagnosis itself is in doubt","code":"M218.2 (panel) and M218.3 (fluorescence in situ hybridisation)","test":"Structural variant detection for TMPRSS2-ERG, NTRK1, NTRK2 and NTRK3 on the tumour, or fluorescence in situ hybridisation for TMPRSS2-ERG alone","opens":"Nothing on its own: the directory's eligibility says these are only required if there is doubt over the origin of a tumour on morphology and prostate carcinoma is in the differential. An NTRK fusion would open an NTRK inhibitor through the tumour-agnostic route","how":"This is a pathologist's test, not a patient's request. It is worth knowing it exists because the commonest genetic event in prostate cancer, the TMPRSS2-ERG fusion, present in about half of tumours, currently opens no treatment at all and is used only to confirm that a poorly differentiated tumour came from the prostate","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (clinical indication M218, prostate cancer, with tests M218.1, M218.2 and M218.3)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"}]},{"target":"PSMA PET-CT","code":"imaging: not appraised and not in NICE guidance","test":"A positron emission tomography scan using a prostate-specific membrane antigen tracer","opens":"In the NHS, nothing that NICE has written down. It is used in practice for staging high-risk disease and for restaging biochemical relapse, and access varies by region","how":"Ask, but know where you stand. NG131 contains no recommendation on PSMA PET-CT anywhere. NICE looked at it in a 2023 exceptional surveillance review of the guideline, noted a study reporting 27 percent greater accuracy than conventional imaging and topic experts' concern about geographical inequity of access, and decided not to change the bone-scan recommendations, saying it would keep monitoring the evidence. NG131's actual position on restaging after biochemical relapse is recommendation 1.3.54: do not routinely offer MRI before salvage radiotherapy, and offer an isotope bone scan if symptoms or the PSA trend suggest metastases. Any claim that NICE recommends choline or PSMA PET-CT at a given PSA level is European Association of Urology guidance, not NICE","sources":[{"label":"NICE: 2023 exceptional surveillance of NG131 (2 March 2023), which decided not to update the bone-scan recommendations and said it would continue monitoring the evidence on gallium-68 PSMA PET-CT","url":"https://www.nice.org.uk/guidance/ng131/resources/2023-exceptional-surveillance-of-prostate-cancer-diagnosis-and-management-nice-guideline-ng131-pdf-14749949286853","date":"2023-03-02"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"},{"label":"NICE TA930: lutetium-177 vipivotide tetraxetan (Pluvicto) for PSMA-positive hormone-relapsed metastatic prostate cancer after two or more treatments, NOT recommended (15 November 2023)","url":"https://www.nice.org.uk/guidance/ta930","date":"2023-11-15"}]}],"testsNote":{"text":"Prostate cancer has the smallest genomic footprint of any common cancer in the NHS test directory: one clinical indication, M218, with three tests, and two germline codes. That is not an oversight. The directory follows what a result would change, and in prostate cancer almost nothing in the tumour changes a decision except a BRCA1 or BRCA2 mutation, which opens a PARP inhibitor. The commonest genetic event in the disease, the TMPRSS2-ERG fusion, is in the directory only as a way of confirming that a poorly differentiated tumour came from the prostate.\n\nThe order of testing is the thing most often got wrong, and the directory is explicit about it: somatic tumour testing under M218.1 first, and germline testing under R444.2 only where there is not enough tissue or the somatic test has failed. R430, inherited prostate cancer, is a different animal: a family-history and ancestry indication, an eight-gene panel rather than BRCA alone, requestable by urology as well as by genetics, and sited at presentation rather than at progression. From 2027 a BRCA2 result from that route will do something no genomic test in prostate cancer has done before: it will put a man into a screening programme.\n\nWhat is missing is any published figure for how often any of this happens. There is no turnaround standard in the directory and no published national genomic turnaround statistic for prostate cancer, and the National Prostate Cancer Audit does not report biomarker testing rates. So the NHS funds PARP inhibitors for BRCA-mutated hormone-relapsed disease, specifies the test that finds them, and cannot say what proportion of eligible men are tested. The codes above were read from the directory workbooks themselves, which open where the directory's own pages do not.","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (clinical indication M218, prostate cancer, with tests M218.1, M218.2 and M218.3)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NHS England: National Genomic Test Directory for rare and inherited disease, version 9 of 8 April 2026 (R430 inherited prostate cancer and R444.2, the prostate arm of the PARP inhibitor indication)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-04-08"},{"label":"NHS England: rare and inherited disease eligibility criteria, version 9.1 of 20 May 2026 (the R430 testing criteria: prostate cancer under 50, Ashkenazi Jewish ancestry at any age, a grandparent from Whalsay at any age, metastatic disease under 60, or a CanRisk score above 10 percent)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","date":"2026-05-20"},{"label":"NHS England: national genomic test directories (publication page)","url":"https://www.england.nhs.uk/publication/national-genomic-test-directories/","date":"2026-07-16"},{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"}]},"trials":[{"trialId":"transform-prostate","registry":"ISRCTN13801649","name":"TRANSFORM: the trial that will decide whether Britain screens for prostate cancer","status":"Recruiting; stage 1 opened 21 November 2025 and is due to close 1 June 2027, with an overall end date of 1 December 2027","setting":"Men aged 50 to 74 in the general population, plus men aged 45 to 49 recorded as being of Black ethnicity or on the learning disability quality outcomes framework register; four prostate health checks against usual care in a multi-arm multi-stage platform, with two pre-consent randomisation designs; stage 1 target 16,000","sites":["Invitation is by GP record across the UK; co-ordinated from Imperial College London with University College London Hospitals","Community diagnostic centres rather than hospitals, to reach men who would not attend one"],"url":"https://www.isrctn.com/ISRCTN13801649","note":"Sponsors Imperial College Healthcare NHS Trust and UCLH; funded by Prostate Cancer UK and the NIHR. Principal investigator Hashim Ahmed. At least one in ten stage 1 invitations goes to Black men, and the government said on 2 June 2026 that it would fund the expansion so that all eligible Black men are invited at stage 2."},{"registry":"ISRCTN11171089 and NCT05574647","name":"IP7-PACIFIC: fast MRI instead of the full scan","status":"Recruiting since 2 November 2022, to 28 February 2027","setting":"Men referred with suspected prostate cancer: biparametric MRI, which drops the contrast injection and takes about a third of the time, with image-fusion targeted biopsy, against the standard multiparametric pathway; target 3,600","sites":["15 UK centres including Southend, Southampton, Medway Maritime and Basingstoke"],"url":"https://www.isrctn.com/ISRCTN11171089","note":"Sponsor Imperial College London, chief investigator Hashim Ahmed, funded by Cancer Research UK. The UK National Screening Committee named it in its March 2026 coversheet as one of the studies that will tell it whether biparametric MRI can replace multiparametric MRI, which matters because a screening programme cannot be built on a scan that needs a contrast injection."},{"registry":"ISRCTN11447662 and NCT06280781","name":"IP9-ATLAS: how much monitoring does active surveillance actually need","status":"Recruiting since 24 May 2024, to 30 June 2027","setting":"Men on active surveillance for localised prostate cancer: regular MRI against the NICE-defined standard monitoring schedule; target 1,263","sites":["12 UK centres including Heatherwood in Ascot, Darent Valley in Dartford, Bradford Royal Infirmary and St Peter's in Chertsey"],"url":"https://www.isrctn.com/ISRCTN11447662","note":"Sponsor Imperial College London, funded by the NIHR. It is testing the protocol in table 2 of NG131, which NICE has flagged for update."},{"registry":"ISRCTN66357938 and NCT06320067","name":"STAMPEDE2: the platform trial, second edition","status":"Recruiting since 11 June 2024, to 31 December 2028","setting":"Metastatic hormone-sensitive prostate cancer: a multi-arm multi-stage platform adding stereotactic ablative radiotherapy or lutetium-177 PSMA to standard of care; target 3,360","sites":["18 UK sites listed on the registry, including Addenbrooke's in Cambridge, the Royal Devon University Hospital in Exeter and Mount Vernon"],"url":"https://www.isrctn.com/ISRCTN66357938","note":"Sponsor University College London, run from the MRC Clinical Trials Unit; chief investigators Nicholas James and Gert Attard. This is where men in the UK can currently receive lutetium-177 PSMA, which NICE and the Scottish Medicines Consortium have both refused."},{"registry":"ISRCTN14434966","name":"ELIPSE: does taking the lymph nodes out during prostatectomy do any good","status":"Recruitment window 1 September 2024 to 31 August 2026; verify before travelling","setting":"High-risk localised prostate cancer: radical prostatectomy with or without pelvic lymph node dissection; target 1,080","sites":["Sponsored by Cardiff and Vale University Health Board, recruiting across the UK"],"url":"https://www.isrctn.com/ISRCTN14434966","note":"Chief investigators Krishna Narahari and Rakesh Heer, funded by the NIHR Health Technology Assessment Programme. A test of a step that is done because it has always been done."},{"registry":"ISRCTN11089334","name":"POINTER-PC: how to treat a node that lights up after treatment","status":"Recruiting since 1 December 2024, to 30 November 2028","setting":"Nodal recurrence after previous radical treatment: extended nodal irradiation in 5 or 20 fractions against stereotactic body radiotherapy to the involved node; target 480","sites":["Sponsored by the University of Leeds, recruiting across the UK"],"url":"https://www.isrctn.com/ISRCTN11089334","note":"Chief investigator Ann Henry, funded by Cancer Research UK and Yorkshire Cancer Research. The question PSMA PET-CT created: it finds single nodes that nobody used to see, and nobody knows what to do with them."},{"registry":"ISRCTN17215075","name":"INTENSIFY: what to do when the PSA does not fall far enough","status":"Recruiting from 31 August 2026, to 31 July 2029","setting":"Metastatic hormone-sensitive prostate cancer with a PSA of 0.2 nanograms per millilitre or more after six months of androgen deprivation therapy and an androgen receptor pathway inhibitor: add docetaxel or continue; biomarker-stratified by Decipher score and PTEN status; target 518","sites":["Sponsored by University Hospital Southampton, recruiting across the UK"],"url":"https://www.isrctn.com/ISRCTN17215075","note":"Chief investigator Simon Crabb, funded by Prostate Cancer UK. It uses an early PSA response as the signal to escalate, which is the practical version of the question the audit's fourth indicator asks."},{"registry":"ISRCTN16448082","name":"STAR-TRAP: radiotherapy to buy time before changing the drug","status":"Recruiting since 19 December 2024, to 18 December 2026","setting":"Metastatic prostate cancer where only a few sites are progressing: stereotactic radiotherapy to those sites to postpone a change of systemic treatment; target 236","sites":["Recruiting across the UK"],"url":"https://www.isrctn.com/ISRCTN16448082","note":"The prostate version of a question British radiotherapy trials keep asking: whether treating the few places that are growing is worth more than changing the drug for everything."},{"registry":"NCT06952803","name":"EvoPAR-PR02: a PARP inhibitor before the cancer ever spreads","status":"Recruiting since 6 August 2025","setting":"BRCA-altered high-risk localised prostate cancer: saruparib, a PARP1-selective inhibitor, or placebo added to radiotherapy and androgen deprivation therapy, with metastasis-free survival as the endpoint; target 700","sites":["16 UK sites including Aberdeen, Bristol, Cambridge and Edinburgh"],"url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=saruparib%20prostate%20cancer","note":"Sponsor AstraZeneca. Registered on ClinicalTrials.gov rather than ISRCTN, so the link is the NIHR Be Part of Research record, because this page cites UK public sources only. If it works it moves PARP inhibition from the last line to the first."},{"registry":"NCT06357416","name":"The Man Van Project: taking the PSA test to the men who do not come","status":"Recruiting since 13 April 2022","setting":"Community outreach PSA testing in a mobile unit, targeting under-served men in London, especially Black men and men in deprived boroughs; target 4,000","sites":["The Royal Marsden mobile unit, London"],"url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=Man%20Van%20prostate","note":"Sponsor The Royal Marsden. The screening committee's objection to population screening is about the balance of benefit and harm; this study is about a different problem, which is that the men at highest risk are the least likely to be tested at all."},{"registry":"NCT03151629","name":"IRONMAN: the registry for men with advanced disease","status":"Recruiting since 21 July 2017","setting":"An international observational registry of men with advanced prostate cancer, collecting treatment, outcome and quality of life data; target 5,000","sites":["13 UK sites including Southampton, Lister in Stevenage, Mount Vernon and Velindre in Cardiff"],"url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=IRONMAN%20prostate%20registry","note":"Registered on ClinicalTrials.gov; the link is the NIHR Be Part of Research record. Registries are how the questions nobody will randomise get answered."}],"trialsNote":{"text":"ISRCTN is the UK registry. Its record pages open in a browser but not to a program, so an agent reading this page should use the registry's public interface rather than the link. A search of that interface returned 486 records matching prostate on the check date. The split between registries matters for anyone looking for a trial: ISRCTN carries the publicly funded academic portfolio, funded by the NIHR, Cancer Research UK, Prostate Cancer UK and Yorkshire Cancer Research, while almost the entire industry portfolio running in UK centres sits on ClinicalTrials.gov and is invisible on ISRCTN. Two of the studies above, EvoPAR-PR02 and IRONMAN, and the Man Van project, have no ISRCTN record, so they link to the NIHR's Be Part of Research search instead; that site renders in the browser only, so nothing on it could be read directly.\n\nThe British prostate trial portfolio has an unusual shape. Most countries' prostate trials test drugs; a disproportionate share of Britain's test whether a step in the pathway is worth taking at all. IP7-PACIFIC asks whether a faster scan will do. IP9-ATLAS asks how much monitoring active surveillance needs. ELIPSE asks whether the lymph node dissection helps. POINTER-PC asks what to do with a node that only exists because a better scan found it. That is the same instinct that produced ProtecT and STAMPEDE, and it is why the NHS pathway looks different from the American one.","sources":[{"label":"ISRCTN13801649: TRANSFORM, trial of randomised approaches for national screening for men. Stage 1 recruitment from 21 November 2025, target 16,000; two pre-consent randomisation designs allocating men to one of four prostate health checks or to a control group; principal investigator Hashim Ahmed","url":"https://www.isrctn.com/ISRCTN13801649","date":"2025-12-30"},{"label":"NIHR Be Part of Research: prostate cancer studies open in the UK","url":"https://bepartofresearch.nihr.ac.uk/results/search-results?query=prostate%20cancer","date":"2026-09-25"},{"label":"ISRCTN11171089: IP7-PACIFIC, biparametric MRI and image-fusion targeted biopsy against the standard diagnostic pathway","url":"https://www.isrctn.com/ISRCTN11171089","date":"2026-09-25"},{"label":"ISRCTN11447662: IP9-ATLAS, approaches to long-term active surveillance","url":"https://www.isrctn.com/ISRCTN11447662","date":"2026-09-25"},{"label":"ISRCTN14434966: ELIPSE, radical prostatectomy with or without pelvic lymph node dissection in high-risk localised prostate cancer","url":"https://www.isrctn.com/ISRCTN14434966","date":"2026-09-25"}]},"legacy":[{"title":"ProtecT and PROMIS (1999 to 2023): Britain asked whether finding it and treating it helps, and published the answer","trialIds":["protect","promis"],"story":"ProtecT is the only randomised trial in the world that has compared active monitoring, surgery and radiotherapy for PSA-detected localised prostate cancer, and it exists because Freddie Hamdy in Oxford, Jenny Donovan and Athene Lane in Bristol and David Neal in Cambridge were willing to ask men to accept a coin toss that might mean no treatment at all. Between 1999 and 2009 the trial PSA-tested 82,429 men aged 50 to 69 across nine UK centres, diagnosed 2,664 with localised disease and randomised 1,643: 545 to active monitoring, 553 to radical prostatectomy and 545 to radiotherapy.\n\nAt ten years there had been 17 prostate cancer deaths in total and no significant difference between the arms. At fifteen years, with follow-up complete for 98 percent of the men, 45 had died of prostate cancer: 17 of 545 on active monitoring (3.1 percent), 12 of 553 after prostatectomy (2.2 percent) and 16 of 545 after radiotherapy (2.9 percent), with a p value of 0.53. All-cause death was 21.7 percent and similar across arms. Metastases were commoner with monitoring, 51 against 26 and 27, and so was clinical progression, 141 against 58 and 60, and more men on monitoring eventually started long-term hormone therapy. But 133 of the 545 men randomised to active monitoring, almost one in four, were alive at the end of follow-up having never had any prostate cancer treatment at all. More than a third of the trial had intermediate or high risk disease at diagnosis, and no baseline factor predicted a differential mortality effect.\n\nDonovan's patient-reported outcomes are the other half of the result, and they are what NICE prints in box 2 of NG131: at six months, moderate to severe urinary incontinence in 4 in 100 on monitoring, 19 after surgery and 6 after radiotherapy; moderate or severe erectile dysfunction in 29, 66 and 48. PROMIS then attacked the step before all of this. Hashim Ahmed and Mark Emberton gave 576 men an MRI, a transrectal biopsy and a template mapping biopsy and compared all three: MRI had 93 percent sensitivity for clinically significant cancer against 48 percent for the standard biopsy, and used as a triage test it would spare 27 percent of men a biopsy and find up to 18 percent more significant cancers. Between them the two trials wrote the modern NHS pathway: scan before you cut, and once you have found it, monitoring is a treatment and not a failure to treat.","sources":[{"label":"Hamdy FC and others. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. New England Journal of Medicine 2016;375:1415-1424 (PMID 27626136)","url":"https://europepmc.org/article/MED/27626136","date":"2016-09-14"},{"label":"Hamdy FC and others. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. New England Journal of Medicine 2023;388:1547-1558 (PMID 36912538)","url":"https://europepmc.org/article/MED/36912538","date":"2023-03-11"},{"label":"Ahmed HU and others. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 2017;389:815-822 (PMID 28110982)","url":"https://europepmc.org/article/MED/28110982","date":"2017-02-25"},{"label":"ISRCTN20141297: ProtecT, prostate testing for cancer and treatment","url":"https://www.isrctn.com/ISRCTN20141297","date":"2026-09-25"},{"label":"ISRCTN16082556: PROMIS, the prostate MRI imaging study","url":"https://www.isrctn.com/ISRCTN16082556","date":"2026-09-25"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"}]},{"title":"STAMPEDE (2005 to 2023): one control arm, ten questions, four changes to standard of care","trialIds":["stampede"],"story":"STAMPEDE is the multi-arm multi-stage platform trial that the rest of oncology copied. Run from the MRC Clinical Trials Unit at UCL with Nicholas James as chief investigator, it recruited 11,992 men starting first-line long-term androgen deprivation therapy between October 2005 and March 2023, and tested comparison after comparison against a single shared control arm.\n\nFour of its answers changed practice. Adding docetaxel to hormone therapy lifted median survival from 71 to 81 months, a hazard ratio of 0.78, while zoledronic acid did nothing at all (hazard ratio 0.94): the trial that put six cycles of chemotherapy at the front of the metastatic pathway and took a bisphosphonate out of it. Adding abiraterone with prednisolone to hormone therapy in men not previously treated with hormones gave a hazard ratio for death of 0.63 and for treatment failure of 0.29, results so clear the comparison was reported at a median 40 months. Radiotherapy to the prostate in newly diagnosed metastatic disease was a negative trial overall, hazard ratio 0.92 across 2,061 men, and a positive one in the prespecified low metastatic burden group, where the long-term analysis found a hazard ratio of 0.64 and five-year survival of 65 percent against 53: the canonical example in British oncology of a subgroup that survived a negative primary because it was specified in advance. And in 1,974 men with high-risk non-metastatic disease, two years of abiraterone added to hormone therapy and radiotherapy gave a metastasis-free survival hazard ratio of 0.53 and an overall survival hazard ratio of 0.60, with six-year metastasis-free survival of 82 percent against 69; adding enzalutamide on top added toxicity and nothing else.\n\nWhat happened next is the British part of the story. Because abiraterone had gone generic, no company had a commercial reason to take that last result to NICE. Wales made the drug available through a One Wales decision in November 2022; NHS England took until 16 January 2026, and did it through a clinical commissioning policy for an off-label use rather than an appraisal. Both the Welsh decision and the English Blueteq form carry STAMPEDE's exact eligibility criteria, and the English form carries an explicit exception to keep supplying abiraterone to men who were in the trial when it closed.","sources":[{"label":"James ND and others. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 2016;387:1163-1177 (PMID 26719232)","url":"https://europepmc.org/article/MED/26719232","date":"2016-03-19"},{"label":"James ND and others. Abiraterone for prostate cancer not previously treated with hormone therapy. New England Journal of Medicine 2017;377:338-351 (PMID 28578639)","url":"https://europepmc.org/article/MED/28578639","date":"2017-07-27"},{"label":"Parker CC and others. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018;392:2353-2366 (PMID 30355464)","url":"https://europepmc.org/article/MED/30355464","date":"2018-12-01"},{"label":"Parker CC and others. Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: long-term results from the STAMPEDE randomised controlled trial. PLOS Medicine 2022;19(6):e1003998 (PMID 35671701)","url":"https://europepmc.org/article/MED/35671701","date":"2022-06-07"},{"label":"Attard G and others. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet 2022;399:447-460 (PMID 34953525)","url":"https://europepmc.org/article/MED/34953525","date":"2022-01-29"},{"label":"ISRCTN78818544: STAMPEDE, systemic therapy in advancing or metastatic prostate cancer, evaluation of drug efficacy","url":"https://www.isrctn.com/ISRCTN78818544","date":"2026-09-25"},{"label":"NHS England clinical commissioning policy 2312: abiraterone acetate and prednisolone for high-risk, hormone-sensitive, non-metastatic prostate cancer in adults (published 21 May 2026, funded from 16 January 2026). Routine commissioning of an off-label use, for two years, on the STAMPEDE eligibility criteria","url":"https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","date":"2026-05-21"},{"label":"All Wales Therapeutics and Toxicology Centre: One Wales decision OW20, abiraterone with prednisolone for non-metastatic and locally advanced high-risk hormone-sensitive prostate cancer, an off-label use with no NICE appraisal. Original decision November 2022, last reviewed April 2024, restricted to newly diagnosed high-risk disease with node-positive disease or two or more of stage T3 or T4, Gleason 8 to 10 and PSA of 40 nanograms per millilitre or more","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/abiraterone-for-hormone-sensitive-prostate-cancer/","date":"2024-04"}]},{"title":"CHHiP and PACE-B (2002 to 2026): the trials that took prostate radiotherapy from 37 visits to 5","trialIds":["chhip","pace-b"],"story":"In 2002 a man having radical radiotherapy for prostate cancer came to hospital 37 times over seven and a half weeks. Today the NHS standard is 20 visits over four weeks, and for a subgroup it is five visits over one or two. Both changes were made by British trials run from the Institute of Cancer Research's Clinical Trials and Statistics Unit.\n\nCHHiP, led by David Dearnaley with Emma Hall as statistical lead, randomised 3,216 men at 71 centres between October 2002 and June 2011 to 74 Gy in 37 fractions, 60 Gy in 20 or 57 Gy in 19, all delivered with intensity modulated radiotherapy. At a median 62 months, five-year freedom from biochemical or clinical failure was 88.3 percent, 90.6 percent and 85.9 percent: 60 Gy in 20 fractions was non-inferior with a hazard ratio of 0.84, 57 Gy in 19 was not, and late bowel and bladder toxicity at grade 2 or worse was no worse on the shorter schedule. The paper's own words were that 60 Gy in 20 fractions is recommended as a new standard of care, and NICE NG131 recommendation 1.3.19 says exactly that.\n\nPACE-B, led by Nicholas van As from The Royal Marsden, then took the same argument further. It randomised 874 men with low or intermediate risk localised disease, none on androgen deprivation therapy, at 38 centres between August 2012 and January 2018, to 36.25 Gy in five fractions of stereotactic body radiotherapy or to the conventional or moderately hypofractionated comparator. At a median 74 months, five-year freedom from failure was 95.8 percent against 94.6 percent, meeting the non-inferiority margin. It also published the cost: late grade 2 or worse genitourinary toxicity at five years was 26.9 percent with the five-fraction schedule against 18.3 percent, though the five-year patient-reported outcomes found no difference in pad use, leakage, sexual problems or bowel problems. On 15 June 2026 NHS England made prostate stereotactic ablative radiotherapy routinely commissioned, writing its eligibility criteria directly out of PACE-B and citing the trial by name, and expects it to be offered at all 48 English radiotherapy providers.","sources":[{"label":"Dearnaley D and others. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncology 2016;17:1047-1060 (PMID 27339115)","url":"https://europepmc.org/article/MED/27339115","date":"2016-08-01"},{"label":"van As N and others. Phase 3 trial of stereotactic body radiotherapy in localized prostate cancer. New England Journal of Medicine 2024;391:1413-1425 (PMID 39413377)","url":"https://europepmc.org/article/MED/39413377","date":"2024-10-17"},{"label":"Cooper S and others. Five-year patient-reported outcomes from the PACE-B randomised trial. European Urology 2026 (PMID 42476886)","url":"https://europepmc.org/article/MED/42476886","date":"2026"},{"label":"ISRCTN97182923: CHHiP, conventional or hypofractionated high-dose intensity modulated radiotherapy for prostate cancer","url":"https://www.isrctn.com/ISRCTN97182923","date":"2026-09-25"},{"label":"ISRCTN17627211: PACE, prostate advances in comparative evidence","url":"https://www.isrctn.com/ISRCTN17627211","date":"2026-09-25"},{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"},{"label":"NICE NG131 recommendations: multiparametric MRI first line reported on a 5-point Likert scale (1.2.2), MRI-influenced biopsy at Likert 3 or more (1.2.3), the Cambridge Prognostic Group table (1.2.15), treatment by risk group (1.3.8 to 1.3.12), the active surveillance protocol (1.3.14), 60 Gy in 20 fractions (1.3.19) and the follow-up PSA intervals (1.3.47)","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","date":"2021-12-15"}]}],"figures":[{"label":"New cases a year","value":"57,898","nation":"UK","period":"2019, 2021-2022 average","source":{"label":"Cancer Research UK: prostate cancer incidence (around 57,900 new cases a year in the UK, 14 percent of all new cancer cases; incidence by ethnic group in England, 2013 to 2017)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence","date":"2026-09-25"},"note":"Around 160 a day, 14 percent of all new cancer cases and the second most common cancer in the UK. Incidence is up 54 percent since the early 1990s and 7 percent in the last decade, and is projected to reach around 85,100 a year by 2038 to 2040. Rates are highest at ages 75 to 79, which is 18 percent of all new cases."},{"label":"Deaths a year","value":"12,300","nation":"UK","period":"2022-2024 average","source":{"label":"Cancer Research UK: prostate cancer mortality (around 12,300 deaths a year; mortality rates 11 percent higher in the most deprived fifth than the least)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/mortality","date":"2026-09-25"},"note":"The second most common cause of cancer death in men. Mortality is down 11 percent in the last decade and is projected to fall a further 4 percent by 2038 to 2040. Death rates peak at age 90 and over, which is around 18 percent of deaths."},{"label":"Ten-year survival","value":"78.9%","nation":"UK","period":"2018 (predicted)","source":{"label":"Cancer Research UK: prostate cancer survival (10-year survival 78.9 percent in the UK; five-year survival by deprivation group in England)","url":"https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/survival","date":"2026-09-25"},"note":"Around eight in ten. Five-year survival in England for men diagnosed 2015 to 2019 was 87.5 percent, and 90.4 percent for men who survived the first year. A population average, not a personal prognosis."},{"label":"Lifetime risk of diagnosis, Black men against White men","value":"29.3% against 13.3%","nation":"England","period":"2008-2010","source":{"label":"Lloyd T, Hounsome L, Mehay A, Mee S, Verne J, Cooper A. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Medicine 2015;13:171. The source of the one-in-four figure, with the ranges and the finding that case fatality is the same in every ethnic group","url":"https://europepmc.org/article/MED/26224061","date":"2015-07-30"},"note":"Roughly one in four against one in eight. The ranges across three methods of assigning unknown ethnicity were 23.5 to 37.2 percent for Black men and 13.2 to 15.0 percent for White men; Asian men were 7.9 percent. These are ranges, not confidence intervals."},{"label":"Lifetime risk of dying of prostate cancer, Black men against White men","value":"8.7% against 4.2%","nation":"England","period":"2008-2010","source":{"label":"Lloyd T, Hounsome L, Mehay A, Mee S, Verne J, Cooper A. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008-2010. BMC Medicine 2015;13:171. The source of the one-in-four figure, with the ranges and the finding that case fatality is the same in every ethnic group","url":"https://europepmc.org/article/MED/26224061","date":"2015-07-30"},"note":"The same paper's least-quoted finding matters as much: within every ethnic group the ratio of lifetime death risk to lifetime diagnosis risk was close to one third, so once diagnosed the chance of dying of the disease was about the same whatever the man's ethnicity. The excess is in incidence, not in case fatality."},{"label":"Age-standardised incidence rate, Black men against White men","value":"166 against 56.4 per 100,000, with a 30% higher mortality rate","nation":"UK","period":"cited in the 2026 equality impact assessment","source":{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"},"note":"The government's own assessment of the targeted screening programme, which also records that Black men would rarely be eligible for it, because the evidence on the prevalence of BRCA2 variants in Black men is itself thin."},{"label":"Incidence rate ratio, Black against White males, by age","value":"2.9 times higher at ages 0 to 64; 1.9 times higher at 65 and over; 2.1 overall","nation":"England","period":"2013-2017","source":{"label":"Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. British Journal of Cancer 2022;126:1765-1773. Prostate cancer incidence rate ratio, Black against White males, 2.1 overall, 2.9 at ages 0 to 64 and 1.9 at 65 and over","url":"https://europepmc.org/article/MED/35233070","date":"2022-03-01"},"note":"The age split is the decision-relevant figure and is rarely quoted. Prostate cancer is the most common cancer in the Black ethnic group in England; in every other broad ethnic group it is breast cancer."},{"label":"Metastatic at diagnosis","value":"12% in England and 20% in Wales","nation":"England and Wales","period":"England 2022, Wales April to December 2023","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"5,696 of 45,599 men in England, down from 6,161 in 2021 and from 17 percent the year before; 316 of 1,600 in Wales. The range between English specialist multidisciplinary teams was 5 to 19 percent."},{"label":"Men with CPG 1 localised disease who receive radical treatment anyway","value":"7%, ranging from 2% to 40% between specialist teams","nation":"England","period":"men diagnosed in 2022","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"383 of 5,453 men. A twentyfold spread between the 45 English specialist multidisciplinary teams on a decision NICE has written down: recommendation 1.3.8 says offer active surveillance in CPG 1. Wales was also 7 percent, ranging from 3 to 10 percent across four health boards."},{"label":"Men with high-risk or locally advanced disease who receive radical treatment","value":"69%, ranging from 46% to 87% between specialist teams","nation":"England","period":"men diagnosed in 2022","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"12,333 of 17,966 men. The audit's first recommendation is to find out why the other 31 percent did not, by case-note review, and to assess fitness for treatment regardless of chronological age. Wales was 68 percent, ranging from 48 to 87 percent."},{"label":"Systemic treatment intensification in newly diagnosed hormone-sensitive metastatic disease, by age","value":"66% under 75 against 29% at 75 and over","nation":"England","period":"within 12 months of diagnosis, men diagnosed in 2022","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"1,803 of 2,728 men under 75, ranging from 39 to 87 percent between teams; 867 of 2,951 men aged 75 and over, ranging from 11 to 57 percent. Overall only 47 percent of English men received intensification. This is the largest inequity the audit measures and it is by age, not by geography."},{"label":"Radical prostatectomies a year","value":"9,590, up 13% on 2023","nation":"England","period":"2024","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"Radical radiotherapy courses rose 13 percent too, from 18,385 to 20,782. Wales did 314 prostatectomies in 2023, up 23 percent, and 935 radical radiotherapy courses."},{"label":"Emergency readmission within 90 days of radical prostatectomy","value":"12%, ranging from 5% to 25% between trusts","nation":"England","period":"surgery between April 2023 and March 2024","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"1,060 of 8,868 men across 49 surgical centres. Wales was 14 percent across five health boards, ranging from 0 to 33 percent."},{"label":"Complications needing an intervention within two years of radical treatment","value":"6% genitourinary after prostatectomy; 8% gastrointestinal and 6% genitourinary after radiotherapy","nation":"England","period":"radical treatment between September 2021 and August 2022","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"395 of 6,357 after surgery, ranging from 0 to 21 percent between providers; 1,092 of 13,329 and 752 of 13,364 after radiotherapy. The genitourinary indicator after radiotherapy was new in the 2025 report."},{"label":"28-day Faster Diagnosis Standard, suspected urological cancer","value":"67.8% against 79.3% for all cancers","nation":"England","period":"July 2026","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},"note":"15,077 of 22,234 people, on 24,449 urgent suspected cancer referrals for suspected urological malignancy in that month: the worst-performing tumour group on the standard, eleven and a half points below the all-cancer figure."},{"label":"62-day standard, prostate cancer, by route","value":"68.2% overall; 62.8% on the urgent suspected cancer route and 85.2% on the consultant upgrade route","nation":"England","period":"July 2026","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},"note":"2,888 of 4,234 men, against 71.2 percent for all cancers. Across April to July 2026 the prostate figure was 65.8 percent on 16,781 treatments. England stops the clock when active monitoring is agreed, counting it as a first treatment, which is why this is not comparable with Scotland's."},{"label":"62-day standard, prostate cancer","value":"39.8% against a 95% standard","nation":"Scotland","period":"quarter ending 31 March 2026","source":{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},"note":"415 of 1,044 men, with a median wait of 77 days and a maximum of 336. Urology as a whole was 47.5 percent, the worst tumour group; all cancers were 72.2 percent. By board it ranged from 10.5 percent in NHS Grampian, median wait 160 days, and 17.3 percent in NHS Lothian, to 81.1 percent in NHS Lanarkshire."},{"label":"31-day standard, prostate cancer","value":"91.4% (England) and 91.7% (Scotland)","nation":"England and Scotland","period":"July 2026 (England); quarter ending 31 March 2026 (Scotland)","source":{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},"note":"8,244 of 9,015 in England, split 96.7 percent for first treatments and 86.4 percent for subsequent ones; 1,478 of 1,612 in Scotland, median wait two days. Northern Ireland reports urological cancer as one group: 171 of 204 in March 2026 against a 98 percent target."},{"label":"62-day standard, all cancers","value":"60.1% against a 75% target","nation":"Wales","period":"July 2026","source":{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 2,248 pathways started treatment in July and 60.1 percent started within 62 days of first being suspected of cancer, against a 75 percent target; 18,429 new suspected cancer pathways were opened, the second highest since records began. No prostate-specific figure is published","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},"note":"2,248 pathways started treatment and 18,429 new suspected cancer pathways were opened, the second highest figure since records began. Wales publishes no tumour-site split in this release."},{"label":"62-day standard, all cancers, after correction","value":"29.6%","nation":"Northern Ireland","period":"quarter ending 31 March 2026","source":{"label":"Northern Ireland Department of Health: revised 62-day waits for quarters ending December 2023 to March 2026 (published 11 September 2026), after an error in the encompass patient administration system's suspension logic inflated performance: 29.6 percent in the quarter to 31 March 2026, and every earlier quarter revised down by up to 4.5 percentage points","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"},"note":"Republished on 11 September 2026 after an error in the encompass patient administration system's suspension logic. Every quarter from December 2024 was revised down, by as much as 4.5 percentage points. Northern Ireland publishes no tumour-site 62-day split."},{"label":"Data completeness: TNM staging and Gleason score","value":"TNM 70% (range 6% to 96%); Gleason 81% (range 11% to 96%)","nation":"England","period":"2025 audit","source":{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},"note":"Wales was 62 percent for TNM and 87 percent for Gleason. Every stage-at-diagnosis figure for prostate cancer in England is a percentage of a staged subset, not of all men, and the subset is three quarters of the whole at best."},{"label":"Men living with or after prostate cancer","value":"Around 540,000","nation":"UK","period":"2020 prevalence base, last updated January 2026","source":{"label":"Prostate Cancer UK (Specialist Nurses on 0800 074 8383; registered charity 1005541 in England and Wales and SC039332 in Scotland)","url":"https://prostatecanceruk.org/","date":"2026-09-25"},"note":"More than 470,000 in England, 32,700 in Scotland, 28,000 in Wales and 13,000 in Northern Ireland, on Prostate Cancer UK's reading of Macmillan's 2020 prevalence work. Macmillan's own 2026 statement puts the current figure at around 600,000; the two rest on different vintages of the same method."}],"support":[{"institutionId":"prostate-cancer-uk","name":"Prostate Cancer UK","kind":"charity","provides":["Specialist Nurses on 0800 074 8383, by telephone, WhatsApp, email and online chat, Monday, Tuesday, Thursday and Friday 9 to 5 and Wednesday 10 to 5","A separate Risk Information Service on 0800 448 0821 for men who have not been diagnosed and want to talk through their risk and the PSA test","A 30-second online risk checker, which the charity says more than 190,000 Black men have completed","The Stronger Knowing More campaign for Black men, and a one-to-one peer support service matching a man with a trained Black volunteer who has had prostate cancer","Information on every stage from a raised PSA to advanced disease, an online community, and nurse-led webinars on living with hormone therapy","Co-funder and co-sponsor of TRANSFORM, the trial that will decide whether Britain screens"],"url":"https://prostatecanceruk.org/","source":{"label":"Prostate Cancer UK (Specialist Nurses on 0800 074 8383; registered charity 1005541 in England and Wales and SC039332 in Scotland)","url":"https://prostatecanceruk.org/","date":"2026-09-25"}},{"institutionId":"cruk","name":"Cancer Research UK","kind":"charity","provides":["Freephone nurse helpline on 0808 800 40 40, Monday to Friday 9 to 5","Plain-English information on prostate cancer and a clinical trial database","The UK statistics quoted on this page","It designed the screening committee's own infographic on what screening would do to 1,000 men, and it supported the committee's 2026 recommendation in the consultation"],"url":"https://www.cancerresearchuk.org/about-cancer/prostate-cancer","source":{"label":"Cancer Research UK: prostate cancer information for patients, with the freephone nurse helpline","url":"https://www.cancerresearchuk.org/about-cancer/prostate-cancer","date":"2026-09-25"}},{"institutionId":"macmillan-cancer-support","name":"Macmillan Cancer Support","kind":"charity","provides":["Support line on 0808 808 00 00, 8am to 8pm every day, with online chat","Separate information for early, locally advanced and advanced prostate cancer, and an online community prostate forum","Money and benefits advisers on the same number, Monday to Friday","Note that Macmillan Grants are no longer available nationally: the page now lists the local areas where they survive and directs everyone else to its money advisers and benefits calculator"],"url":"https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer","source":{"label":"Macmillan Cancer Support: prostate cancer (support line 0808 808 00 00, 8am to 8pm every day)","url":"https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer","date":"2026-09-25"}},{"institutionId":"maggies-centres","name":"Maggie's","kind":"charity","provides":["Centres across the UK beside major cancer hospitals, plus online support; support line 0300 123 1801","Free, with no appointment and no referral needed","One-to-one support with a psychologist, a benefits adviser or a cancer support specialist, and courses and groups in centres and online"],"url":"https://www.maggies.org/","source":{"label":"Maggie's","url":"https://www.maggies.org/","date":"2026-09-25"}},{"name":"Tackle Prostate Cancer","kind":"charity","provides":["The federation of local prostate cancer support groups across the UK, registered as the National Federation of Prostate Cancer Support Groups","Patient-led: the groups are run by men who have had the disease","Make Sense of It, a one-to-one treatment decision support service pairing a newly diagnosed man, or his partner, with a trained decision buddy"],"url":"https://tackleprostate.org/","source":{"label":"Tackle Prostate Cancer, the federation of UK prostate cancer support groups","url":"https://tackleprostate.org/","date":"2026-09-25"}},{"name":"Prostate Scotland and Prostate Cancer Research","kind":"charity","provides":["Prostate Scotland: information and support for men in Scotland, including which urology units do what; it opposed the screening committee's 2026 draft recommendation in the consultation","Prostate Cancer Research: funds research into advanced disease, runs The Infopool patient site, and leads Prostate Progress, the programme NHS England began inviting 500,000 men to join on 1 August 2026"],"url":"https://www.prostatescotland.org.uk/","source":{"label":"Prostate Cancer Research","url":"https://www.prostate-cancer-research.org.uk/","date":"2026-09-25"}},{"name":"NHS prostate cancer information and the PSA test","kind":"nhs","provides":["Symptoms, causes, tests and treatment on nhs.uk, reviewed 31 July 2025","The PSA test page, which is where the withdrawn Prostate Cancer Risk Management Programme addresses now redirect, with the preparation rules and what the result does and does not mean","It states plainly that routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test"],"url":"https://www.nhs.uk/conditions/prostate-cancer/","source":{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"}},{"name":"Free NHS prescriptions in England (medical exemption certificate)","kind":"benefit","provides":["Anyone being treated for cancer, the effects of cancer or the effects of cancer treatment is entitled to a medical exemption certificate, valid five years for cancer; ask the hospital or GP for form FP92A","Everyone aged 60 and over is exempt anyway, which covers most men with prostate cancer"],"url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","source":{"label":"NHS: prescription charges","url":"https://www.nhs.uk/nhs-services/prescriptions/nhs-prescription-charges/","date":"2026-09-25"}},{"name":"Prescriptions in Scotland, Wales and Northern Ireland","kind":"benefit","provides":["Scotland: free for everyone since 2011, with no certificate needed","Wales: free for anyone registered with a Welsh GP since 2007","Northern Ireland: all prescriptions dispensed there have been free since 2010"],"url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","source":{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2026-09-25"}},{"name":"Personal Independence Payment and Attendance Allowance","kind":"benefit","provides":["Non-means-tested payments for people whose illness or treatment affects daily living or mobility: Personal Independence Payment under State Pension age, Attendance Allowance over it","In Scotland these are Adult Disability Payment and Pension Age Disability Payment","Incontinence, fatigue on hormone therapy and the effects of pelvic radiotherapy are exactly the kinds of daily-living difficulty these are meant for, and men under-claim them"],"url":"https://www.gov.uk/pip","source":{"label":"GOV.UK: Attendance Allowance","url":"https://www.gov.uk/attendance-allowance","date":"2026-09-25"}},{"name":"Special rules for end of life (SR1)","kind":"benefit","provides":["If a doctor, consultant or specialist nurse says you may have 12 months or less to live, claims for Personal Independence Payment, Universal Credit, Employment and Support Allowance and Attendance Allowance are fast-tracked at the higher rate with no assessment","The SR1 form replaced the DS1500; the clinician completes and usually submits it"],"url":"https://www.gov.uk/benefits-end-of-life","source":{"label":"DWP: the special rules, how the benefit system supports people nearing the end of life (the SR1 form, for clinicians)","url":"https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","date":"2026-09-25"}},{"name":"Healthcare Travel Costs Scheme","kind":"benefit","provides":["Help with fares to hospital for people on qualifying benefits or a low income","It matters here because radical prostate radiotherapy is 20 visits over four weeks on the standard schedule, and because Northern Ireland has two radiotherapy centres and Wales two"],"url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","source":{"label":"NHS: Healthcare Travel Costs Scheme","url":"https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","date":"2026-09-25"}}],"nations":[{"topic":"Screening","england":"Ministers agreed on 2 June 2026 to implement the UK National Screening Committee's recommendation: a nationally managed approach to biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer, with rollout expected in 2027. No population screening, and no targeted screening for Black men or for family history without a BRCA2 variant.","scotland":"The UK National Screening Committee advises all four nations, and ministers in each decide whether to implement. No separate Scottish implementation decision could be found on a public page.","wales":"As Scotland: the recommendation applies to Wales through the committee, but no separate Welsh implementation decision could be found.","northernIreland":"As Scotland and Wales: no separate Northern Ireland implementation decision could be found.","sources":[{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"},{"label":"UK National Screening Committee: screening for prostate cancer, coversheet of 26 March 2026 (the modelling summary by strategy, the 12-week consultation with its 974 comments, and the recommendation in full with its rationale for excluding BRCA1 carriers, Black men and family history without a BRCA2 variant)","url":"https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","date":"2026-03-26"},{"label":"Department of Health and Social Care: equality impact assessment, introduction of a targeted prostate cancer screening programme (published 2 June 2026). Ministers in England have agreed to implement biennial PSA testing for men aged 45 to 61 with a pathogenic germline BRCA2 variant and a relevant family history. Carries the England case and death counts, the survival figure, the lifetime risk by ethnic group and the age-standardised incidence rates for Black and White men","url":"https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","date":"2026-06-02"}]},{"topic":"The PSA test if you have no symptoms","england":"No programme and no threshold. The Prostate Cancer Risk Management Programme has been withdrawn and its GOV.UK addresses redirect to the NHS PSA test page; the Department of Health and Social Care has said patient information moves to NHS channels and GP guidance to NICE Clinical Knowledge Summaries. Anyone with a prostate can ask a GP for the test after a discussion of benefits and harms.","scotland":"As England: the risk management programme was a UK-wide arrangement and its withdrawal applies throughout.","wales":"As England.","northernIreland":"As England.","sources":[{"label":"NHS: PSA test (the page the withdrawn Prostate Cancer Risk Management Programme addresses now redirect to). It says routine PSA testing is not offered on the NHS unless genetic tests have shown a faulty BRCA2 gene, and that anyone with a prostate can ask a GP about the test. Page last reviewed 2 September 2024","url":"https://www.nhs.uk/tests-and-treatments/psa-test/","date":"2024-09-02"},{"label":"UK National Screening Committee: prostate cancer recommendation, from the March 2026 review. Screening is recommended, but only as a targeted programme: biennial PSA testing for men aged 45 to 61 with a pathogenic BRCA2 variant and a family history of breast, ovarian, pancreatic or prostate cancer. Population screening is not recommended, and nor is targeted screening for any other risk group. Next review estimated 2029 to 2030","url":"https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","date":"2026-03"}]},{"topic":"Waiting-time standards and how prostate cancer does against them","england":"28 days to diagnosis or all-clear at 80 percent, 31 days from decision to treat at 96 percent and 62 days from referral at 85 percent. In July 2026 suspected urological cancer achieved 67.8 percent on the 28-day standard, the worst tumour group, and prostate cancer achieved 68.2 percent at 62 days and 91.4 percent at 31 days.","scotland":"31 days from decision to treat and 62 days from an urgent suspicion of cancer referral, both at 95 percent. In the quarter to March 2026 prostate cancer achieved 39.8 percent at 62 days and 91.7 percent at 31 days, against all-cancer figures of 72.2 and 94.5 percent. No NHS board met the 62-day standard. England stops the 62-day clock when active monitoring is agreed and Scotland's publication does not say whether it does the same, so the two are not directly comparable.","wales":"A single suspected cancer pathway measured from the point of suspicion, with a 75 percent target at 62 days; 60.1 percent in July 2026 for all cancers. No prostate-specific figure is published in the monthly summary.","northernIreland":"31 days at 98 percent and 62 days at 95 percent. The 62-day figures were withheld from the March 2026 release and the whole series republished on 11 September 2026 after an error in the encompass system's suspension logic; the corrected all-cancer figure for the quarter to March 2026 is 29.6 percent. Only a urological group figure is published for the 31-day standard.","sources":[{"label":"NHS England: cancer waiting times monthly combined data, April to July 2026, provisional. The prostate and urological rows for July 2026: 67.8 percent on the 28-day standard for suspected urological malignancies, 68.2 percent on the 62-day standard for prostate cancer overall, 62.8 percent on the urgent suspected cancer route and 85.2 percent on the consultant upgrade route, and 91.4 percent on the 31-day standard","url":"https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","date":"2026-09-10"},{"label":"GOV.UK: waiting times for suspected and diagnosed cancer patients, July 2026 (the definitions of the 28, 31 and 62 day standards; published 10 September 2026)","url":"https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","date":"2026-09-10"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"},{"label":"Welsh Government: NHS activity and performance summary, July and August 2026 (published 17 September 2026): 2,248 pathways started treatment in July and 60.1 percent started within 62 days of first being suspected of cancer, against a 75 percent target; 18,429 new suspected cancer pathways were opened, the second highest since records began. No prostate-specific figure is published","url":"https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","date":"2026-09-17"},{"label":"Northern Ireland Department of Health: revised 62-day waits for quarters ending December 2023 to March 2026 (published 11 September 2026), after an error in the encompass patient administration system's suspension logic inflated performance: 29.6 percent in the quarter to 31 March 2026, and every earlier quarter revised down by up to 4.5 percentage points","url":"https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","date":"2026-09-11"},{"label":"Northern Ireland Department of Health: cancer waiting times statistics by HSC trust and tumour site, January to March 2026. Urological cancer 31-day performance: 179 of 204 in January, 172 of 200 in February and 171 of 204 in March, against a 98 percent target","url":"https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-q4-25-26.xlsx","date":"2026-07-02"}]},{"topic":"The national audit","england":"The National Prostate Cancer Audit covers every NHS trust; the 2025 State of the Nation report, published October 2025, covers men diagnosed or treated between September 2021 and March 2024, with eight performance indicators reported at specialist multidisciplinary team, trust and cancer alliance level.","scotland":"Not in the audit. Public Health Scotland publishes cancer waiting times with a prostate split, which England does not publish at board level.","wales":"In the audit, at health board level: 2,402 men diagnosed in 2023, five surgical centres and three radiotherapy centres reported.","northernIreland":"Not in the audit. The Northern Ireland Cancer Registry at Queen's University Belfast publishes incidence, stage and survival separately.","sources":[{"label":"National Prostate Cancer Audit: State of the Nation Report 2025, full report. 58,218 men diagnosed in England in 2024, up 9 percent on 2023; 9,590 radical prostatectomies and 20,782 radical radiotherapy courses in 2024; the eight performance indicators with their provider ranges; and the data completeness figures","url":"https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","date":"2025-10"},{"label":"National Prostate Cancer Audit (NATCAN, Royal College of Surgeons of England): the prostate audit","url":"https://www.natcan.org.uk/audits/prostate/","date":"2026-09-25"},{"label":"Public Health Scotland: cancer waiting times, table 1, compliance with standard (quarter ending 31 March 2026). Urology overall 47.5 percent at 62 days; prostate 39.8 percent on 1,044 eligible referrals, with a median wait of 77 days and a maximum of 336; by board from 10.5 percent in Grampian and 17.3 percent in Lothian to 81.1 percent in Lanarkshire. Prostate 31-day compliance 91.7 percent on 1,612 referrals","url":"https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","date":"2026-06-30"}]},{"topic":"Who decides drug funding","england":"NICE technology appraisals, funded through baseline commissioning; the Cancer Drugs Fund currently carries no prostate indication at all. Two prostate indications are funded by NHS England commissioning policy rather than by appraisal: upfront abiraterone in metastatic hormone-sensitive disease from December 2024, and abiraterone in high-risk non-metastatic disease from January 2026.","scotland":"The Scottish Medicines Consortium, with the Patient and Clinician Engagement process for end of life and orphan medicines. Twenty-five prostate advices; it refuses one medicine England funds, darolutamide with androgen deprivation therapy, because Bayer made no submission.","wales":"NICE appraisals apply, and health boards must fund a recommended medicine within two months of the final appraisal determination under the new treatment fund directions of 2017. The All Wales Medicines Strategy Group appraises only what NICE has not, and all four of its prostate advices are marked superseded or excluded.","northernIreland":"NICE appraisals are not automatic. Each is reviewed by the Department of Health for legal, policy and financial consequences, usually within four weeks of final publication, may be endorsed with caveats, and is then issued as a service notification with implementation expected within three months and completion within a further six. Negative appraisals are endorsed too.","sources":[{"label":"NHS England: national Cancer Drugs Fund list, version 1.408 of 24 September 2026, read in full. Section A is the Cancer Drugs Fund proper and contains no prostate indication; every prostate row sits in section B, routinely commissioned, with its Blueteq form reference","url":"https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","date":"2026-09-24"},{"label":"Scottish Medicines Consortium: medicines advice, keyword search for prostate (the site's own search parameter; the medicines-advice index without it returns the most recent advice only)","url":"https://scottishmedicines.org.uk/medicines-advice/?keywords=prostate","date":"2026-09-25"},{"label":"Welsh Government: new treatment fund, directions on implementation timescales, WHC/2017/001 (21 April 2017). Health boards must make medicines recommended by NICE and the All Wales Medicines Strategy Group available within two months of the first publication of the final appraisal determination, with a three-month timescale only in exceptional circumstances notified to the Chief Medical Officer","url":"https://www.gov.wales/new-treatment-fund-directions-implementation-timescales-whc2017001","date":"2017-04-21"},{"label":"Northern Ireland Department of Health: circular HSC (SQSD) 12/22, NICE technology appraisals, process for endorsement, implementation, monitoring and assurance in Northern Ireland (1 April 2022). NICE guidance does not apply automatically: it is reviewed for applicability, may be endorsed with caveats, and trusts are expected to plan implementation within three months of the service notification and to complete it within a further six","url":"https://www.health-ni.gov.uk/publications/circular-hsc-sqsd-12-22-nice-technology-appraisals-process-endorsement-implementation-monitoring-and-assurance-northern-ireland","date":"2022-04-01"},{"label":"NHS England clinical commissioning policy 2312: abiraterone acetate and prednisolone for high-risk, hormone-sensitive, non-metastatic prostate cancer in adults (published 21 May 2026, funded from 16 January 2026). Routine commissioning of an off-label use, for two years, on the STAMPEDE eligibility criteria","url":"https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","date":"2026-05-21"}]},{"topic":"Where the four nations actually differ on drugs","england":"Funds darolutamide with androgen deprivation therapy in hormone-sensitive metastatic disease (TA1109) and everything else in the funding table above. It reached abiraterone for high-risk non-metastatic disease on 16 January 2026.","scotland":"Funds everything England funds except darolutamide with androgen deprivation therapy, which it refused as a non-submission in June 2026. It was earlier than NICE on abiraterone in metastatic hormone-sensitive disease (by nineteen months on the first appraisal, TA721, which refused it, and by nearly six years on TA1110, which recommended it), on olaparib for BRCA-mutated disease (by a year on TA831, and by a year and a half on TA887, which replaced it) and on talazoparib with enzalutamide (by eleven months). It agrees with England on every refusal, including lutetium-177 PSMA, which it refused twice.","wales":"Follows NICE, so funds everything England funds. It also got to abiraterone for high-risk non-metastatic hormone-sensitive disease first, through One Wales decision OW20 in November 2022, more than three years before England.","northernIreland":"Follows NICE through the endorsement process, with a lag measured in weeks to months rather than years.","sources":[{"label":"NICE TA1109: darolutamide with androgen deprivation therapy for hormone-sensitive metastatic prostate cancer (12 November 2025), only if docetaxel is not suitable, and use the least expensive of the suitable options","url":"https://www.nice.org.uk/guidance/ta1109","date":"2025-11-12"},{"label":"SMC2940: darolutamide (Nubeqa) with androgen deprivation therapy for metastatic hormone-sensitive prostate cancer, non-submission, not recommended (8 June 2026)","url":"https://scottishmedicines.org.uk/medicines-advice/darolutamide-nubeqa-nonsub-smc2940/","date":"2026-06-08"},{"label":"All Wales Therapeutics and Toxicology Centre: One Wales decision OW20, abiraterone with prednisolone for non-metastatic and locally advanced high-risk hormone-sensitive prostate cancer, an off-label use with no NICE appraisal. Original decision November 2022, last reviewed April 2024, restricted to newly diagnosed high-risk disease with node-positive disease or two or more of stage T3 or T4, Gleason 8 to 10 and PSA of 40 nanograms per millilitre or more","url":"https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/abiraterone-for-hormone-sensitive-prostate-cancer/","date":"2024-04"},{"label":"NHS England clinical commissioning policy 2312: abiraterone acetate and prednisolone for high-risk, hormone-sensitive, non-metastatic prostate cancer in adults (published 21 May 2026, funded from 16 January 2026). Routine commissioning of an off-label use, for two years, on the STAMPEDE eligibility criteria","url":"https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","date":"2026-05-21"},{"label":"NICE TA930: lutetium-177 vipivotide tetraxetan (Pluvicto) for PSMA-positive hormone-relapsed metastatic prostate cancer after two or more treatments, NOT recommended (15 November 2023)","url":"https://www.nice.org.uk/guidance/ta930","date":"2023-11-15"},{"label":"SMC2966: lutetium (177Lu) vipivotide tetraxetan (Pluvicto), non-submission, not recommended for use within NHSScotland for PSMA-positive metastatic castration-resistant prostate cancer after an androgen receptor pathway inhibitor (10 August 2026)","url":"https://scottishmedicines.org.uk/medicines-advice/lutetium-177lu-vipivotide-tetraxetan-pluvicto-nonsub-smc2966/","date":"2026-08-10"},{"label":"SMC2753: talazoparib (Talzenna) with enzalutamide for metastatic castration-resistant prostate cancer where chemotherapy is not clinically indicated, accepted (10 March 2025), eleven months before NICE","url":"https://scottishmedicines.org.uk/medicines-advice/talazoparib-talzenna-abb-smc2753/","date":"2025-03-10"}]},{"topic":"Radiotherapy and where it is delivered","england":"48 radiotherapy providers. Stereotactic ablative radiotherapy for low and intermediate risk localised disease became routinely commissioned on 15 June 2026 and is expected at all of them; NHS England estimates around 3,500 men a year will choose it.","scotland":"Five regional cancer centres. The Beatson in Glasgow and the Edinburgh Cancer Centre are the two prostate brachytherapy centres, and Edinburgh was the first in Scotland to offer high dose rate brachytherapy, in October 2021. The NHS England SABR policy does not apply.","wales":"Velindre Cancer Centre in Cardiff for the south east, with a unit at Abergavenny, plus radiotherapy at other health boards; Velindre offers both high and low dose rate brachytherapy. A new Velindre centre is due to open in 2027.","northernIreland":"Two centres: the Northern Ireland Cancer Centre at Belfast City Hospital, which provides brachytherapy, and the North West Cancer Centre at Altnagelvin in Londonderry, opened November 2016 with three linear accelerators and a catchment including north Donegal.","sources":[{"label":"NHS England clinical commissioning policy 2106: stereotactic ablative radiotherapy for localised prostate cancer (adults), published 15 June 2026. SABR is now routinely commissioned as an alternative to moderately hypofractionated external beam radiotherapy for low and intermediate risk localised disease in men who do not need androgen deprivation therapy, at 36.25 Gy in five fractions, on the PACE-B criteria. It replaces the 2016 policy and asks for at least two subspecialist clinical oncologists with prostate SABR experience and radiotherapy trials quality assurance compliance before a centre may offer it","url":"https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","date":"2026-06-15"},{"label":"NHS England: the NHS is to offer multi-beam precision radiotherapy to thousands with prostate cancer (10 June 2026), which says around 17,500 men a year in England are diagnosed with low or intermediate risk disease, that modelling suggests around 3,500 a year will choose stereotactic ablative radiotherapy, and that it is expected to be offered at all 48 radiotherapy providers in England","url":"https://www.england.nhs.uk/2026/06/nhs-to-offer-multi-beam-precision-radiotherapy-to-thousands-with-prostate-cancer/"},{"label":"Beatson West of Scotland Cancer Centre: brachytherapy, with a dedicated brachytherapy theatre suite and two high dose rate suites, listed among its national services for Scotland","url":"https://www.beatson.scot.nhs.uk/patients-and-visitors/about-cancer/treatment-therapies/brachytherapy/","date":"2026-09-25"},{"label":"Velindre University NHS Trust: Velindre Cancer Centre, which delivers intensity modulated radiotherapy, stereotactic radiotherapy, high and low dose rate brachytherapy and molecular radiotherapy for South East Wales","url":"https://velindre.nhs.wales/","date":"2026-09-25"},{"label":"Belfast Health and Social Care Trust: the Northern Ireland Cancer Centre at Belfast City Hospital, the regional provider of radiotherapy, brachytherapy and chemotherapy","url":"https://belfasttrust.hscni.net/services/cancer/treatments/the-northern-ireland-cancer-centre/","date":"2026-09-25"},{"label":"Western Health and Social Care Trust: the North West Cancer Centre at Altnagelvin Hospital, Londonderry, Northern Ireland's second radiotherapy centre, opened November 2016","url":"https://westerntrust.hscni.net/hospitals/north-west-cancer-centre/","date":"2026-09-25"}]},{"topic":"Genomic testing route","england":"Seven Genomic Laboratory Hubs run clinical indication M218 for somatic BRCA1 and BRCA2 testing, with R430 and R444.2 for germline testing. Version 16 of the cancer directory is dated 16 July 2026 and version 9 of the rare and inherited disease directory 8 April 2026.","scotland":"The Scottish Genomic Test Directory, through four regional laboratories.","wales":"The All Wales Medical Genomics Service.","northernIreland":"The Northern Ireland Regional Genetics Centre in Belfast.","sources":[{"label":"NHS England: National Genomic Test Directory for cancer, non-central nervous system, version 16.0 of 16 July 2026 (clinical indication M218, prostate cancer, with tests M218.1, M218.2 and M218.3)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","date":"2026-07-16"},{"label":"NHS England: National Genomic Test Directory for rare and inherited disease, version 9 of 8 April 2026 (R430 inherited prostate cancer and R444.2, the prostate arm of the PARP inhibitor indication)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","date":"2026-04-08"},{"label":"NHS England: rare and inherited disease eligibility criteria, version 9.1 of 20 May 2026 (the R430 testing criteria: prostate cancer under 50, Ashkenazi Jewish ancestry at any age, a grandparent from Whalsay at any age, metastatic disease under 60, or a CanRisk score above 10 percent)","url":"https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","date":"2026-05-20"}]},{"topic":"Prescription charges","england":"9.90 pounds an item unless exempt; anyone being treated for cancer or its effects gets a five-year medical exemption certificate, and everyone over 60 is exempt, which covers most men with prostate cancer.","scotland":"Free for everyone since 2011; no certificate needed.","wales":"Free for anyone registered with a Welsh GP since 2007.","northernIreland":"Free: all prescriptions dispensed there have been free since 2010.","sources":[{"label":"NHS: prescription charges","url":"https://www.nhs.uk/nhs-services/prescriptions/nhs-prescription-charges/","date":"2026-09-25"},{"label":"NHS Business Services Authority: medical exemption certificates (five years for cancer, the effects of cancer or its treatment)","url":"https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","date":"2026-09-25"},{"label":"NHS inform: prescription charges and exemptions (prescriptions in Scotland are free)","url":"https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","date":"2026-09-25"},{"label":"Welsh Government: free prescriptions","url":"https://www.gov.wales/free-prescriptions","date":"2026-09-25"},{"label":"nidirect: help with health costs (all prescriptions dispensed in Northern Ireland are free of charge)","url":"https://www.nidirect.gov.uk/articles/help-health-costs","date":"2026-09-25"}]}],"gaps":["Five NHS England pages open in a browser but return nothing to a program: the National Genomic Test Directory, the Cancer Drugs Fund list, the cancer waiting times pages, the stereotactic ablative radiotherapy announcement and the Prostate Progress announcement. The documents they link to do open, and that is where the figures on this page were read. An agent or a screen reader working from the links alone will see less than a person does.","Wales publishes no prostate or urological waiting-time figure that could be read. The monthly NHS activity and performance summary reports all cancers together; StatsWales has migrated to stats.gov.wales, where the cancer waiting times dataset does carry a tumour-site dimension but offers no comma-separated or interface download route that resolved, and the legacy open data host no longer answers at all. Northern Ireland publishes no 62-day split by tumour site, and its urological 31-day figure groups prostate with bladder, kidney and testis.","England's 62-day prostate figure of 68.2 percent and Scotland's of 39.8 percent are not directly comparable and should not be read as a league table. England stops the 62-day clock for men in the lower Cambridge Prognostic Groups at the point active monitoring is agreed, counting that as a first treatment. Whether Scotland or Wales do the same could not be established: neither publication mentions active monitoring or surveillance anywhere, and the Scottish Government's clinical review of the waiting-time standards does not define first treatment at that level.","Cancer Research UK has moved most of its rate-level breakdowns into interactive data hubs, so no age-standardised incidence or mortality rate per 100,000 for UK prostate cancer could be read from a CRUK page, and no one-year survival figure is published there at all. The incidence and mortality counts, the survival figures and the deprivation splits quoted here are the ones CRUK still prints in the served HTML. The age-standardised rates for Black and White men on this page come from the Department of Health and Social Care's equality impact assessment instead.","There is no four-way stage split at diagnosis for prostate cancer in England on any page that could be read. CRUK publishes only an early-stage aggregate, 53 percent of staged cases in 2022, and the nearest verified proxy for advanced disease is the audit's metastatic-at-diagnosis indicator, 12 percent, which is an M1 measure and not a TNM stage 4 measure. Both sit on top of staging that is only 70 percent complete in England, with a provider range from 6 to 96 percent, so every English stage percentage is a percentage of a subset.","The National Prostate Cancer Audit publishes no active surveillance uptake figure. It measures surveillance inversely, through the proportion of CPG 1 men who receive radical treatment, and there is no published number for how many men are on active surveillance at any time. It also publishes no time-to-treatment indicator and no patient-reported outcomes in the 2025 report, and no biomarker testing rates, so there is no figure for what proportion of men with hormone-relapsed metastatic disease are tested for BRCA1 and BRCA2. The 2026 State of the Nation patient and public report carries a publication date of 8 October 2026 and had no document attached on the check date.","The audit publishes no other-cause mortality by ethnicity or deprivation, which is the figure that would settle whether the gap between Black and White men closes under equal access. Its indicators are all process or complication measures; ethnicity appears nowhere in the 2025 State of the Nation report's published indicator tables.","Two national minimum-volume standards for prostate surgery are both live and they disagree. NHS England service specification 170114S of February 2019 asks for at least 100 cases a centre and 25 a surgeon; clinical commissioning policy B14/P/a of October 2015 asks for at least 150 robot-assisted laparoscopic radical prostatectomies a year, gave itself a review date of April 2017 and has no published successor; GIRFT's urology report of July 2018 proposed 40 a centre and 20 a surgeon while doubting the premise. Neither NHS England document names a single centre. The British Association of Urological Surgeons closed its radical prostatectomy data collection on 31 December 2019, so there is no current published surgeon-level or unit-level outcome data in the UK; the centre cards here are built from the national audit's workbook instead.","NHS England expects prostate stereotactic ablative radiotherapy to be offered at all 48 English radiotherapy providers but has published no list of the 48, and the policy itself names no centre. Nor is there a published list of the centres that have completed the radiotherapy trials quality assurance step the policy requires before a centre may offer it, so a man cannot find out from a public page whether his centre can give him five fractions instead of twenty.","NHS England's molecular radiotherapy service specification 2322 of September 2024 names no commissioned provider: section 7.8 contains a placeholder reading that the list will be added once available. So even for the radiopharmaceuticals the NHS does fund, such as radium-223, there is no public list of where they are given.","The Institute of Cancer Research's researcher profile pages could not be opened and the site is mid-migration between two address schemes, so no icr.ac.uk profile is cited here. David Dearnaley, who led CHHiP, and Emma Hall, who is statistical lead on both CHHiP and PACE-B, have no readable public page and therefore no record on this page; the Royal Marsden consultant directory is cited for the clinicians who appear in both places.","ISRCTN record pages open in a browser but not to a program, so every trial here was read through the registry's public interface. The NIHR's Be Part of Research site renders in the browser only, so the three studies registered on ClinicalTrials.gov rather than ISRCTN (EvoPAR-PR02, IRONMAN and the Man Van project) are linked to a search page rather than to a record, and their details come from the registry entry read elsewhere. ELIPSE's registered recruitment window closed on 31 August 2026 and no update had been posted, so its row says to verify before travelling.","The TRANSFORM funding figure has moved and neither version could be reconciled on a single page: the trial launched at around 42 million pounds, 26 million from Prostate Cancer UK and 16 million from the NIHR, and the charity's current page states 60 million after the government added up to 18 million more on 2 June 2026. Because the two accounts cannot be reconciled, no single total is quoted above. The four screening strategies the trial compares are not enumerated in the registry record either; they are described only in charity and press material.","Cancer Drugs Fund list row ABI4, which funds upfront abiraterone in newly diagnosed high-risk metastatic hormone-sensitive disease from 13 December 2024, cites an NHS England commissioning policy proposition numbered 2424, and no published document with that reference could be located. The row also still carries no technology appraisal number, although TA1110 was published on 19 November 2025.","NICE's condition-filtered product list for prostate cancer would not open on repeated attempts; the count of 79 products quoted here was read on one successful attempt at the unfiltered address. NICE Clinical Knowledge Summaries, which the Department of Health and Social Care has named as the replacement for the withdrawn risk management programme's GP guidance, could not be opened on any attempt, so what the NHS now tells GPs about PSA testing in Black men could not be read."],"route":"/cancers/prostate/uk/","sources":["https://www.nhs.uk/tests-and-treatments/psa-test/","https://view-health-screening-recommendations.service.gov.uk/prostate-cancer/","https://www.nice.org.uk/guidance/ng12/chapter/Recommendations-organised-by-site-of-cancer","https://www.nhs.uk/conditions/prostate-cancer/tests-and-next-steps/","https://www.nhs.uk/conditions/prostate-cancer/","https://view-health-screening-recommendations.service.gov.uk/review/prostate-cancer-screening-modelling-report-2025/download-documents/cover_sheet/","https://www.nhs.uk/conditions/prostate-cancer/causes/","https://www.gov.uk/government/publications/prostate-cancer-screening-equality-impact-assessment/equality-impact-assessment-introduction-of-a-targeted-prostate-cancer-screening-programme","https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-eligibility-criteria-v9.1.pdf","https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025.pdf","https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Infographic.pdf","https://view-health-screening-recommendations.service.gov.uk/document/728f9536-5010-40e6-9030-748c4bd517d0/download","https://view-health-screening-recommendations.service.gov.uk/document/2b9ef9db-3622-44c3-91ea-a77320d67770/download","https://view-health-screening-recommendations.service.gov.uk/document/90900396-f2b5-4ce5-a25f-07351a4057b0/download","https://europepmc.org/article/MED/26224061","https://europepmc.org/article/MED/35233070","https://www.nice.org.uk/guidance/ng131/chapter/Recommendations","https://europepmc.org/article/MED/39054088","https://prostatecanceruk.org/prostate-information-and-support/risk-and-symptoms/black-men-and-prostate-cancer","https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/2026-27-Apr-Jul-Monthly-Combined-CSV-Provisional.csv","https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Cancer-Waiting-Times-Statistical-Release-July-2026-Provider-based-Provisional.pdf","https://www.gov.uk/government/statistics/waiting-times-for-suspected-and-diagnosed-cancer-patients-for-july-2026","https://www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times/","https://europepmc.org/article/MED/28110982","https://www.nice.org.uk/guidance/htg678","https://www.nice.org.uk/guidance/htg680","https://www.nice.org.uk/guidance/htg237","https://www.nice.org.uk/guidance/ng131/resources/2023-exceptional-surveillance-of-prostate-cancer-diagnosis-and-management-nice-guideline-ng131-pdf-14749949286853","https://www.nice.org.uk/guidance/qs91","https://publichealthscotland.scot/media/39235/2026-06-30-cwt-table-1-compliance-to-standard.xlsx","https://www.health-ni.gov.uk/sites/default/files/2026-07/hs-niwts-cwt-q4-25-26.xlsx","https://publichealthscotland.scot/publications/cancer-waiting-times/cancer-waiting-times-1-january-to-31-march-2026/","https://www.gov.wales/nhs-activity-and-performance-summary-july-and-august-2026-html","https://www.health-ni.gov.uk/sites/default/files/2026-09/ni-cancer-waiting-times-2026-revised.pdf","https://europepmc.org/article/MED/36912538","https://europepmc.org/article/MED/27339115","https://www.england.nhs.uk/wp-content/uploads/2026/06/2106-sabr-prostate-cancer-adult-clinical-commissioning-policy.pdf","https://www.england.nhs.uk/2026/06/nhs-to-offer-multi-beam-precision-radiotherapy-to-thousands-with-prostate-cancer/","https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/10/b14pa-rbtic-asstd-srgry-prostate-cancer-oct15.pdf","https://www.england.nhs.uk/publication/clinical-commissioning-policy-statement-docetaxel-in-combination-with-androgen-deprivation-therapy-for-the-treatment-of-hormone-naive-metastatic-prostate-cancer/","https://www.uclh.nhs.uk/","https://www.natcan.org.uk/wp-content/uploads/2025/10/NPCA-SotN-2025-Data-Tables.xlsx","https://www.isrctn.com/ISRCTN13801649","https://www.royalsurrey.nhs.uk/","https://mse.nhs.uk/","https://www.nbt.nhs.uk/","https://www.uhs.nhs.uk/","https://www.isrctn.com/ISRCTN17215075","https://www.guysandstthomas.nhs.uk/","https://www.leedsth.nhs.uk/services/radiotherapy/brachytherapy/prostate-brachytherapy/","https://www.isrctn.com/ISRCTN11089334","https://www.christie.nhs.uk/","https://www.clatterbridgecc.nhs.uk/","https://europepmc.org/article/MED/39413377","https://www.sth.nhs.uk/","https://www.newcastle-hospitals.nhs.uk/","https://www.royalmarsden.nhs.uk/","https://bepartofresearch.nihr.ac.uk/results/search-results?query=Man%20Van%20prostate","https://www.cuh.nhs.uk/","https://www.isrctn.com/ISRCTN66357938","https://www.imperial.nhs.uk/","https://www.isrctn.com/ISRCTN11171089","https://www.uhb.nhs.uk/","https://www.ouh.nhs.uk/","https://www.nds.ox.ac.uk/team/freddie-hamdy-cbe","https://www.uhbw.nhs.uk/","https://research-information.bris.ac.uk/en/persons/jenny-l-donovan","https://www.hey.nhs.uk/","https://www.nuh.nhs.uk/","https://www.nhsggc.scot/","https://www.nhsggc.scot/robotic-surgery-for-prostate-cancer-restarts-for-patients-in-the-west-of-scotland/","https://www.beatson.scot.nhs.uk/patients-and-visitors/about-cancer/treatment-therapies/brachytherapy/","https://www.nhslothian.scot/","https://cavuhb.nhs.wales/","https://cavuhb.nhs.wales/news/latest-news/celebrating-10-years-of-robotic-assisted-surgery-at-the-university-hospital-of-wales/","https://www.isrctn.com/ISRCTN14434966","https://velindre.nhs.wales/","https://sbuhb.nhs.wales/","https://belfasttrust.hscni.net/services/cancer/treatments/the-northern-ireland-cancer-centre/","https://westerntrust.hscni.net/hospitals/north-west-cancer-centre/","https://www.england.nhs.uk/wp-content/uploads/2019/02/specialised-kidney-bladder-and-prostate-cancer-services-adults.pdf","https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/07/GIRFT-Urology.pdf","https://www.england.nhs.uk/wp-content/uploads/2024/09/2322-molecular-radioherapy-service-specification.pdf","https://www.nice.org.uk/guidance/ta930","https://www.nice.org.uk/guidance/terminated/ta1179","https://scottishmedicines.org.uk/medicines-advice/lutetium-177lu-vipivotide-tetraxetan-pluvicto-nonsub-smc2966/","https://www.england.nhs.uk/wp-content/uploads/2026/01/2312-ccp-abiraterone-acetate-prednisolone-high-risk-hormone-sensitive-non-metastatic-prostate-cancer-adults.pdf","https://scottishmedicines.org.uk/medicines-advice/?keywords=prostate","https://www.nice.org.uk/guidance/ta1110","https://scottishmedicines.org.uk/medicines-advice/abiraterone-acetate-zytiga-full-smc2215/","https://www.nice.org.uk/guidance/ta1109","https://scottishmedicines.org.uk/medicines-advice/darolutamide-nubeqa-nonsub-smc2940/","https://www.nice.org.uk/guidance/ta740","https://scottishmedicines.org.uk/medicines-advice/apalutamide-erleada-abbreviated-smc2579/","https://www.nice.org.uk/guidance/ta951","https://scottishmedicines.org.uk/medicines-advice/olaparib-lynparza-mcrpc-full-smc2617/","https://www.nice.org.uk/guidance/ta887","https://scottishmedicines.org.uk/medicines-advice/olaparib-lynparza-full-smc2366/","https://www.nice.org.uk/guidance/ta1130","https://scottishmedicines.org.uk/medicines-advice/talazoparib-talzenna-abb-smc2753/","https://www.nice.org.uk/guidance/ta391","https://scottishmedicines.org.uk/medicines-advice/cabazitaxel-jevtana-resubmission-73511/","https://www.nice.org.uk/guidance/ta412","https://scottishmedicines.org.uk/medicines-advice/radium-223-xofigo-fullsubmission-107715/","https://www.nice.org.uk/guidance/ta995","https://scottishmedicines.org.uk/medicines-advice/relugolix-orgovyx-full-smc2678/","https://www.nice.org.uk/guidance/ta546","https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/prostate-cancer/products","https://www.england.nhs.uk/wp-content/uploads/2017/04/national-cancer-drugs-fund-list-v1.408.pdf","https://www.england.nhs.uk/publication/national-cancer-drugs-fund-list/","https://www.nice.org.uk/guidance/terminated/ta1032","https://www.nice.org.uk/guidance/terminated/ta994","https://www.nice.org.uk/guidance/ta332","https://awttc.nhs.wales/accessing-medicines/one-wales-medicines-process/ow-decisions/abiraterone-for-hormone-sensitive-prostate-cancer/","https://www.gov.wales/new-treatment-fund-directions-implementation-timescales-whc2017001","https://www.health-ni.gov.uk/publications/circular-hsc-sqsd-12-22-nice-technology-appraisals-process-endorsement-implementation-monitoring-and-assurance-northern-ireland","https://www.health-ni.gov.uk/publications/circular-hsc-sqsd-9-26-nice-guidelines-process-endorsement-implementation-monitoring-and-assurance-northern-ireland","https://www.england.nhs.uk/wp-content/uploads/2018/08/cancer-non-central-nervous-system-national-genomic-test-directory-version-16.xlsx","https://www.england.nhs.uk/wp-content/uploads/2018/08/rare-and-inherited-disease-national-genomics-test-directory-v9.xlsx","https://www.england.nhs.uk/publication/national-genomic-test-directories/","https://www.isrctn.com/ISRCTN11447662","https://www.isrctn.com/ISRCTN16448082","https://bepartofresearch.nihr.ac.uk/results/search-results?query=saruparib%20prostate%20cancer","https://bepartofresearch.nihr.ac.uk/results/search-results?query=IRONMAN%20prostate%20registry","https://bepartofresearch.nihr.ac.uk/results/search-results?query=prostate%20cancer","https://europepmc.org/article/MED/27626136","https://www.isrctn.com/ISRCTN20141297","https://www.isrctn.com/ISRCTN16082556","https://europepmc.org/article/MED/26719232","https://europepmc.org/article/MED/28578639","https://europepmc.org/article/MED/30355464","https://europepmc.org/article/MED/35671701","https://europepmc.org/article/MED/34953525","https://www.isrctn.com/ISRCTN78818544","https://europepmc.org/article/MED/42476886","https://www.isrctn.com/ISRCTN97182923","https://www.isrctn.com/ISRCTN17627211","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/incidence","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/mortality","https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/survival","https://prostatecanceruk.org/","https://www.cancerresearchuk.org/about-cancer/prostate-cancer","https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer","https://www.maggies.org/","https://tackleprostate.org/","https://www.prostatescotland.org.uk/","https://www.prostate-cancer-research.org.uk/","https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/medical-exemption-certificates","https://www.nhs.uk/nhs-services/prescriptions/nhs-prescription-charges/","https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/prescription-charges-and-exemptions/","https://www.gov.wales/free-prescriptions","https://www.gov.uk/pip","https://www.gov.uk/attendance-allowance","https://www.gov.uk/benefits-end-of-life","https://www.gov.uk/government/publications/dwp-factual-medical-reports-guidance-for-healthcare-professionals/the-special-rules-how-the-benefit-system-supports-people-nearing-the-end-of-life","https://www.nhs.uk/nhs-services/help-with-health-costs/healthcare-travel-costs-scheme-htcs/","https://www.natcan.org.uk/audits/prostate/","https://www.nidirect.gov.uk/articles/help-health-costs"]}