After Sir Chris Hoy was diagnosed with terminal Stage 4 prostate cancer in 2023, the six-time Olympic gold-medal winning cyclist embarked on an extraordinary campaign to raise awareness and save lives, while enjoying what is left of his own life with his family.
Hoy has used his platform to promote early detection and to demand wider screening among men. He had no obvious symptoms, but his father and grandfather had both had prostate cancer, which suggests that if he had been tested earlier, his diagnosis could have been manageable rather than terminal.
The publicity Hoy’s story gained in the UK led to a massive surge in visits to the NHS website and the Prostate Cancer UK risk checker, potentially saving lives. He has also raised millions of pounds to fund cancer charities.
With other famous figures, including former UK prime minister David Cameron and actor Stephen Fry, revealing they have had treatment for prostate cancer, the issue is finally receiving more attention. But there is still no national screening programme for men, meaning many continue to die unnecessarily.
What is going wrong? Why are men dying from a cancer that can be detected and cured? The issue is complicated and emotive. But before we address that crucial question, here is everything men need to know…
What is prostate cancer?
“The prostate is a gland found in men, which helps to make semen, the fluid sperm swim in,” explains Chiara De Biase, Prostate Cancer UK’s director of health services, equity and improvement.
“It is about the size and shape of a walnut and surrounds the urethra (the tube that carries urine out of the body) just underneath the bladder. Prostate cancer is where abnormal cells divide and grow in an uncontrolled way.” This can lead to the formation of a cancerous (malignant) tumour.
Prostate cancer cells often grow slowly, making the condition hard to spot, but sometimes the growth can be aggressive and spread quickly to other parts of the body.
Who is most at risk?
In England, prostate cancer is the most common cancer among men. In fact, one in eight men will be diagnosed with prostate cancer in their lifetime. “More than 63,000 men are diagnosed with prostate cancer every year, and over 510,000 men are living with or after prostate cancer,” explains De Biase.
However, some men are more at risk than others.
“Prostate cancer mainly affects men over 50, and your risk increases as you get older,” says De Biase. “There are three main risk factors that increase a man’s risk of the disease, which are age, being black, or having a family history of the disease.
“For black men, their risk is doubled as one in four black men will get prostate cancer, and they are also twice as likely to die from the disease.
"You are also more likely to get prostate cancer if you have a family history of it, compared to a man who has no relatives with prostate cancer, and are two and a half times more likely to get prostate cancer if your father or brother has had it.”
In the UK, men can use Prostate Cancer UK’s 30-second online risk checker or call its Risk Information Service on 0800 448 0821.
What are the symptoms?
A challenging issue with prostate cancer is that it may not cause any symptoms at first, making it hard to spot.
But early-stage symptoms can include blood in the urine, which might make the urine look pink or red; blood in the semen; the urge to urinate more often or more urgently and difficulties trying to urinate; waking up to urinate more often at night.
Symptoms of more advanced cases include accidental leaking of urine, back or bone pain, erectile dysfunction, fatigue, weight loss or weakness in the arms and legs.
How do I get tested?
Doctors can perform tests to find out if you have a prostate problem. The main tests include a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE).
A PSA test measures the amount of prostate specific antigen (PSA) in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. A raised PSA level may suggest you have a problem with your prostate, but not necessarily cancer.
A DRE involves a doctor or nurse feeling your prostate through your bottom to check for any enlargement.
They’ll wear gloves with gel on their finger to make it more comfortable. It might feel a bit embarrassing, but the test isn’t usually painful and it is quick.
If they think you may have a problem, they will make an appointment for you to see a specialist at the hospital for further examination, such as an MRI scan or a biopsy.
What are the best treatment options?
If your cancer is at an early stage, your doctor may suggest 'watchful waiting' or 'active surveillance'.
Treatments for advanced cancer include surgically removing the prostate, radiotherapy (using high-energy rays to kill the cancer), brachytherapy (a form of radiotherapy where the radiation dose is delivered inside the prostate gland), hormone therapy (to block testosterone, which accelerates the cancer’s growth), cryotherapy (freezing cancer cells), chemotherapy (which destroys cancer cells by interfering with the way they multiply) and steroids (to shrink the tumour and stop it growing).
Possible side effects include erectile dysfunction and urinary symptoms, so treatment is usually recommended only in relation to the seriousness of the growth.
The big question: should there be nationwide screening?
Despite being the second most common cancer in the UK after breast cancer, there is no national screening programme in place for prostate cancer.
Indeed, the UK National Screening Committee (NSC) recently advised against mass screening for men. This shocked and disappointed many men.
“I was quite astonished,” said Hoy. “I can’t believe that the answer to this situation is to sit on your hands and do nothing.”
The argument for mass screening is obvious: to save as many men’s lives as possible.
“Prostate cancer is curable if found early, but 12,000 of our dads, brothers, sons and friends die from it each year,” explains De Biase.
“It’s the most common cancer in England, and yet it is the last major cancer without a screening programme.
“We've reached a tipping point in the UK, with too many men dying from a curable disease and worse outcomes for men at higher risk like black men and men from working class communities. It’s about time for a change.”
Some medical experts stress there are big issues to overcome. For a start, the PSA test, the primary screening tool, has limitations, including low sensitivity and potential for false positives. This could lead to overdiagnosis and overtreatment.
The issue with overdiagnosis is some prostate cancers are slow-growing and not aggressive, and would not necessarily require treatment.
The NSC estimated that about 40-50% of prostate cancer cases detected by PSA screening would be slow-growing, and that further treatment and testing for these cancers would lead to high levels of overdiagnosis.
The issue with overtreatment, which might follow as a result, is treatment can cause lifelong side-effects such as incontinence, erectile dysfunction and bladder problems for a cancer that would never have caused harm to the individual.
Instead, the NSC recommends targeted screening for men with BRCA gene mutations. BRCA1 and BRCA2 gene variants are faulty genes, which can increase a person’s risk of developing breast, pancreatic, ovarian and prostate cancer.
Men in that category could be screened every two years between the ages of 45 and 61, the NSC suggests.
While this advance was welcomed by many, experts believe it is not wide-ranging enough. “Prostate Cancer UK were the only charity to submit evidence to the UK National Screening Committee back in 2022 showing that modern diagnosis is safer and more effective than ever, which we strongly believe tipped the balance in favour of targeted screening for men at the highest risk of prostate cancer,” says De Biase.
“But the UK National Screening Committee (NSC), after a detailed evidence review, recommended to reject routine screening for the vast majority of men at high risk of prostate cancer, apart from those with specific gene variations.
“We know that a mass screening programme could save thousands of men’s lives. While screening men with BRCA gene variations will save only a fraction of that, the committee’s decision is the first time they’ve recommended screening of any kind for prostate cancer. It shows that research and evidence can shift the dial and save men’s lives.”
The charity’s £42 million TRANSFORM trial will bring new evidence on the benefits of screening back to the screening committee in the coming years.
It will involve hundreds of thousands of men and include research into other tests, including genetic spit tests and fast MRI scans, which could save lives. Until then, men’s greatest defence against prostate cancer is awareness and action.
The prostate cancer picture in the USA: a comparison
Words: John Whitney
A useful comparison to make with the UK – and to assess the wisdom of the decision on mass screening – is to look at the USA.
The country has a very different healthcare model and a more aggressive approach to finding prostate cancer, even if they also don’t have a national programme. Like the UK, it’s the second most common cancer behind breast cancer.
National Cancer Institute statistics show in 2025 that prostate cancer accounted for 15.4% of all new cancer cases and 5.8% of all deaths in the USA, compared to 14% and 7% in the UK. The five-year survival rate in the USA is 97.9%, compared to 85% in the UK.
So, you could conclude that, proportionally, more prostate cancer is discovered in the USA, fewer people are dying and significantly more people are living five years or more after diagnosis.
Unlike the UK and the National Health Service, there’s no universal health care system in the USA. While there are national programmes for cancer screening, such as breast cancer, there isn’t one for prostate cancer.
The US Preventive Services Task Force (USPSTF), a panel of experts which offers guidelines on preventative screening – and is funded by but independent of the federal government’s Department of Health – says men between 55 and 69 should talk to their doctor about the pros and cons of PSA testing (and recommends against PSA testing for men over 70).
Its warnings of doing so mirror the concerns of overtreatment in the UK: “Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men.
"However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; [and] overdiagnosis and overtreatment.”
That said, more men get a PSA test in the USA than in the UK. National Cancer Institute statistics in 2023 report that 38% of men aged 55-69 in the US had a PSA test in the past 12 months.
Precise figures on UK-wide PSA testing aren’t available, but Prostate Cancer Research calculated 870,000 PSA tests were carried out in 2024, with 440,000 of these on men between 50 and 69, or 5.4%. Although it's a wider age range, it falls far below the USA figure.
