TRANSFORM

TRANSFORM exists because the UK National Screening Committee's March 2026 review could not answer two questions. The first is whether any modern screening pathway does more good than harm in the general population: the committee's modelling said no for PSA alone, because around 40 to 50 percent of screen-detected cancers are slow growing and at age 60 roughly half of screen-detected cases would be overdiagnosed. The second is whether it would do more good than harm in Black men, where the committee found the evidence too thin to say either way.

The trial randomises men, before consent in one of its two designs, between four screening strategies and a control group following usual care. The registry record does not enumerate the four; Prostate Cancer UK and Imperial describe them as combinations of PSA testing, a polygenic risk test and fast biparametric MRI. Stage 1 is a single screening round with a target of 16,000; stage 2 runs at least two rounds. Its eligibility rules are the point: the general invitation starts at 50, but men of Black ethnicity are invited from 45, and the design carries a floor of at least one in ten stage 1 invitations going to Black men. The government said on 2 June 2026 that it would fund the expansion so that from stage 2 all eligible Black men would be invited. The committee has said it will work with the trial team to resolve the uncertainty on Black men as soon as good data exist.