Answering your questions about the expansion of our groundbreaking TRANSFORM trial

The earlier you find prostate cancer, the easier it is to treat. That's why a screening programme is so important. It's a way of checking men early – to find cancer before symptoms show up.

Last week, the Government announced an additional £18m investment in our groundbreaking research trial: TRANSFORM. This expansion of the trial is a major step forward on the path to screening and means that all eligible Black men will be invited to take part in stage 2 of the trial, starting in the next few years. It brings total investment in TRANSFORM to around £60m, making it the largest prostate cancer screening trial for 20 years and the most representative of the UK population ever taken.

But what does this investment in TRANSFORM mean for men? And what’s it got to do with the National Screening Committee’s final recommendation on screening?

We’ve answered some of your key questions.

Why have the Government announced funding for TRANSFORM now – and is this a screening programme?

TRANSFORM is not a national screening programme. It’s a once-in-a-generation research trial to find the safest and most effective screening techniques including combinations of PSA blood tests, fast MRI scans, and genetic risk testing.

The Government’s £18m investment for TRANSFORM comes shortly after the UK National Screening Committee (NSC)’s final recommendation on prostate cancer screening. After reviewing the evidence, the NSC concluded that there are gaps and uncertainties in the data that prevent a mass national screening programme being introduced.

The committee has instead recommended screening for a small group of men aged between 45 and 61 who have both variations in their BRCA2 genes, and a family history of cancer.

This is only a few thousand men – a fraction of the lives we need to save. We’re deeply disappointed that the evidence isn’t yet strong enough for a larger screening programme. We can’t allow those at highest risk, including Black men and men with a family history of the disease, to be left behind.

That’s why the TRANSFORM expansion matters. It’s not a mass screening programme yet - but it is a clear step towards it, as it will help generate the evidence needed to get us screening for all men at risk.

What does the NSC’s BRCA2 gene recommendation mean?

The Government has approved the NSC’s recommendation to screen men aged between 45 and 61 who have both a rare genetic variation that puts them at greater risk (in a gene called BRCA2) and a family history of breast, ovarian, pancreatic or prostate cancer.

We all have BRCA genes, which are passed down to us from our parents. But for a small number of people, these genes contain changes that cause them to stop working properly. When this happens, it’s known as a ‘gene variation’. 

If you have a BRCA2 gene variation, it doesn’t mean you will get prostate cancer. But your risk is higher, so speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Risk Information Service, who can help you understand your risk of prostate cancer.

Why is this Government investment focused on Black men?

Some men face a greater risk of getting prostate cancer than others. 1 in 4 Black men will get prostate cancer – that's double the risk of other men. Black men are also more likely to die from the disease.

But there remain huge gaps in the evidence around Black men and prostate cancer, as they have been significantly underrepresented in research studies. This has prevented the NSC from recommending screening for Black men.  

TRANSFORM is already designed to tackle these gaps and address the health inequalities that Black men face. Stage 1 is already underway, with 10% of all invitations going to Black men. And now, with the additional funding, all eligible Black men (aged 45-74 who have not had a recent PSA test) will be invited to take part in Stage 2, in a few years.

This will ensure that those who are the most likely to get prostate cancer and die from it will have the opportunity to benefit from the latest and best screening techniques, in the safest possible way.

It will get us the vital evidence we need to achieve screening for Black men – and will significantly strengthen the evidence needed to support screening for all men at risk of prostate cancer.

Will this investment help other men who are at risk – like men with a family history of the disease?

Yes. This Government investment will give all men at risk of prostate cancer a better chance of early diagnosis in future.

Increasing the recruitment of Black men will increase the scale of TRANSFORM overall. The expansion not only helps plug critical evidence gaps for Black men, it also means we can better understand how screening works for those most at risk, and make sure it works safely for everyone. It substantially increases the likelihood that TRANSFORM will deliver the evidence needed for safe effective screening for all men at risk of prostate cancer as soon as possible.

It is a truly game changing investment in the future of men’s health and a clear indication in the Government’s support for and belief in our trial to achieve its aims.

Is this effectively screening for Black men via the back door? Is it safe?

The expansion of TRANSFORM is not the same as a decision to screen Black men for prostate cancer. 

Black men are one of the groups that would benefit most from improving early detection of prostate cancer through screening. They are also a group significantly underrepresented in past research and therefore lacking crucial evidence needed to be part of a national screening programme.

TRANSFORM is designed to address that, safely and ethically. The trial has been carefully reviewed and approved by an NHS Ethics Committee as well as numerous patient representatives.

All eligible Black men will receive clear, transparent information about the pros and cons of taking part in the trial, so they can make an informed decision about joining the trial. Taking part is completely voluntary, and no-one will be forced to participate. The final decision rests with the men themselves.

Those who choose to take part will be closely monitored over a period of time and will receive appropriate follow-up treatment if required.

By taking part, men can access the latest, most cutting edge screening approaches - and help build the evidence that will lead to screening for future generations.

While our research builds hope for the future, we provide help right now for men and their loved ones. If you’re worried about prostate cancer or prostate problems, see our support services and choose what works for you.