A Tale of Two Prostates: What Israel Gets Right That Britain Still Gets Wrong

On 28 May 2026, the United Kingdom National Screening Committee delivered its long-awaited verdict on prostate cancer screening. After years of mounting public pressure, headline campaigns by charities and celebrities, and the quiet accumulation of evidence from some of the largest oncology trials ever run, the committee recommended a screening programme — but only for a vanishingly narrow cohort: men aged 45 to 61 who carry a BRCA2 gene variant and who also have a family history of breast, ovarian, pancreatic or prostate cancer. Everyone else, including Black British men with double the lifetime risk of their white counterparts, remains outside the tent.

The committee’s chief investigator on the recent TRANSFORM trial, Professor Hashim Ahmed of Imperial College London, put the rationale unsentimentally: “currently the harms unfortunately outweigh the benefits of population level screening for most high-risk groups and the population as a whole.” But in the same press response, Ahmed went further. He declared himself “deeply disappointed with the recommendation of the National Screening Committee, particularly in relation to black men who have double the risk of getting prostate cancer.” Professor Ros Eeles of the Institute of Cancer Research, who led the IMPACT study, was sharper still. Capping screening at 61 rather than 69, she warned, “misses 42 per cent of prostate cancers in those with a BRCA2 pathogenic alteration.”

In other words: the committee’s own clinical collaborators believe the recommendation is too cautious, too narrow, and indifferent to populations who urgently need a programme. It stands in revealing contrast to how Israel — a far smaller country, with fewer resources per capita and considerably more existential distractions — has quietly built one of the more humane and effective real-world approaches to detecting this disease.

The numbers tell the first half of the story. Prostate cancer is now the most commonly diagnosed cancer in the United Kingdom. Around 12,300 British men die of it every year, roughly 34 every day. Mortality rates are eleven per cent higher in the most deprived communities than in the wealthiest. Cancer Research UK projects 17,500 annual deaths by the late 2030s. Incidence has risen from 109 to 159 per 100,000 person-years between 2000 and 2021. This is not a stable problem. It is an accelerating one. In England, one in four Black men will be diagnosed with prostate cancer in his lifetime — double the one-in-eight risk faced by men generally — and they are twice as likely to die of it.

Israel, by contrast, has watched its prostate cancer incidence rates fall — by an extraordinary 6.2 per cent per year between 2013 and 2017, the steepest decline of any of the fifty countries tracked in the most recent European Urology global analysis. Israel records around 3,300 new cases annually and roughly 400 to 500 deaths. The age-standardised mortality rate sits at roughly half the British level. As Miri Ziv, Vice Chair of the Israel Cancer Association, has summarised: “the incidence rates… are relatively high, but the mortality rates are low — a sign of the optimal treatment given in Israel.” Israeli men get prostate cancer about as often as British men. They simply do not die of it at the same rate.

What explains the divergence? Neither country runs a universal population screening programme. Both, formally, endorse shared decision-making for men aged roughly 50 to 70, or 45 for high-risk groups. On paper, the policies rhyme. In practice, they diverge sharply at the points where bureaucracy meets biology.

Start with access. In Britain, the PSA test is not routinely offered. A man over fifty can request one from his GP, but he must know to ask, know what to ask for, and be confident enough to push back if the GP — operating under National Institute for Health and Care Excellence guidance that emphasises potential harms — gently suggests he wait until symptoms appear. By the time symptoms appear in prostate cancer, the disease is frequently no longer curable. The result is a postcode lottery, a class lottery, and a confidence lottery layered on top of one another. The 2025 National Prostate Cancer Audit confirmed what every urologist in the country already knew: Black men and men in deprived areas are diagnosed later and die more often.

In Israel, the situation is materially different. The country’s four health maintenance organisations — Clalit, Maccabi, Meuhedet and Leumit — operate as integrated primary-care and specialist networks under the National Health Insurance Law of 1995. Every Israeli citizen is automatically a member of one. PSA testing, while not part of a formal population screening programme, is woven into the routine of mid-life primary care. A man approaching fifty in Tel Aviv, Haifa or Beersheba is overwhelmingly likely to have his PSA checked as part of standard preventive monitoring, without needing to advocate for himself. The cultural script is different: in Israel, asking your doctor about your prostate is roughly as remarkable as asking about your cholesterol.

The downstream pathway diverges further. Since 2016, the Israeli national health basket has covered PET-PSMA imaging — the most sensitive form of molecular imaging available for prostate cancer staging — for men with intermediate and high-risk disease, including Gleason 7 and above or PSA above 20. This is not a niche privilege available to the wealthy or the well-connected. It is the standard of care, accessible through the public system. British patients, by contrast, still face significant regional variation in MRI access before biopsy, despite overwhelming evidence that multiparametric MRI dramatically improves biopsy precision and reduces both unnecessary procedures and missed aggressive cancers.

The objection one hears from British policymakers is that PSA testing produces too many false positives, too much overdiagnosis, and too much overtreatment. These concerns are real. They are also addressable — and Israel demonstrates how. Modern Israeli urology routinely combines PSA with MRI, PET-PSMA where indicated, and increasingly with secondary biomarkers, before any decision to biopsy is taken. The Sheba Medical Center, Rabin Medical Center’s Davidoff Cancer Center, and Hadassah-Hebrew University Medical Center in Jerusalem are at the frontier of research into reducing treatment intensity for low-risk disease. The Israeli model is not “test everyone, treat aggressively.” It is “test broadly, investigate carefully, treat precisely.”

Britain has the same diagnostic technologies. It has the same evidence base. What it lacks is the institutional courage to deploy them. The UK National Screening Committee’s final recommendation reflects a particular kind of caution that has become endemic in British public health: a preference for the measurable harms of action over the unmeasurable harms of inaction. Every man whose biopsy resulted in incontinence is counted. Every man who died at sixty-eight because his cancer was found at stage four is, statistically, just part of the baseline. That is the morally tone-deaf accounting at the heart of the British approach.

There is a lesson here for Israeli policymakers too, and it is not one of complacency. Israel’s relative success rests partly on the integrated structure of its health funds and partly on a cultural disposition toward early intervention shaped by decades of operating in a country where waiting is rarely a virtue. As cancer incidence rises across all populations and as Arab Israeli men remain somewhat underserved relative to their Jewish counterparts, the case for formalising what currently happens informally — a structured, equitable, MRI-supported PSA pathway for men from age 50, or 45 for those at elevated risk — grows stronger. The Israel Cancer Association has the credibility and the data to lead this conversation. The Knesset Health Committee would do well to convene it.

The deeper point is philosophical. A screening policy is not merely a technical artefact. It is a statement about how a society values the time, dignity and longevity of its men. Britain has decided, with characteristic understatement, that the risk of a man enduring an unnecessary biopsy outweighs the risk of another man dying needlessly of metastatic disease. Israel has decided, with characteristic pragmatism, that you find the cancer first and manage the consequences second.

Of these two philosophies, only one is consistent with the actual mortality data. The British age-standardised prostate cancer death rate is roughly double the Israeli figure. That is not a coincidence. It is a policy choice.

The United Kingdom National Screening Committee will review its recommendation again. When it does, it could do worse than to study, carefully and without condescension, how a small country in the eastern Mediterranean has been quietly outperforming it for years.

Appendix: UK vs Israel — Prostate Cancer Screening at a Glance

Table A. Screening pathway and system design

Table B. Outcomes and burden of disease

Sources: UK NSC (28/5/26); Cancer Research UK; Prostate Cancer UK; Israel National Cancer Registry; Israel Cancer Association; European Urology 2024 (Bray et al.); GLOBOCAN 2022; Cancer Reports (Hoboken) 2021; SMC reactions, Nov 2025 & May 2026.