Policy report: Active surveillance guidelines in the UK

Published: 12 August 2025

Background

• More than 56,000 men are diagnosed with prostate cancer in the UK annually.
• Estimates suggest a third of men diagnosed with localised, non-metastatic prostate cancer, that isn’t likely to spread or cause harm during their lifetime, are potential candidates for Active Surveillance (AS).
• Overtreatment of these cancers remains a challenge and is one of the reasons why screening for prostate cancer is not currently recommended in the UK.
• AS is a conservative approach where prostate cancer is monitored using PSA and MRI (and potentially biopsy) over a period of years rather than treating immediately.
• The intention is to avoid the harmful side-effects associated with treatments such as surgery or radiotherapy. However, men on surveillance, and their families, can worry about not treating their cancer immediately.

Our research

• To help understand how AS for men with localised prostate cancer is currently being managed in the UK a review of NHS Hospitals’ clinical protocols for the management of AS was undertaken during September 2024 to February 2025.
• Our aim was to understand how AS for men with localised prostate cancer is currently being managed in the UK.
• 75/147 (51%) of NHS Hospital Trusts and Health Boards in the UK responded to a Freedom of Information (FOI) request from which we completed our analysis – comparing what NHS Hospitals told us they do in practice, with current published guidelines and recommendations.

Our findings

• We observed variation in protocols and deviation from NICE NG131 guidelines which are detailed in the report.
• Our study concludes that NICE guidelines for AS must be updated to keep pace with the latest evidence-base and advancing clinical practices, so that men get the benefits from AS and avoid the harms of over-treatment and their associated side-effects.
• More men are being diagnosed with prostate cancer and therefore structured, robust and reliable AS programmes are essential, especially if national screening for prostate cancer is to be introduced in the future.
• We hope the findings and recommendations from this study can support policy- and decision-makers to optimise AS approaches that balance the individual needs of men against the optimal use of NHS resources.

Read the report

Active Surveillance FOI Policy Report August 2025