Cliff Richard's Prostate Cancer and the PSA Screening Question

What he said

The Associated Press reported that Cliff Richard, then 85, told Good Morning Britain he had been given the all-clear after treatment for prostate cancer.

He said he was diagnosed a year earlier, after a health check required by insurers before a tour of Australia and New Zealand. In his words, "the good fortune was that it was not very old, and the other thing is that it has not metastasized." He said the treatment was successful, and added: "I don't know whether it's going to come back."

He called it "absolutely ridiculous" that the United Kingdom has no wide prostate testing program. AP noted that the NHS offers routine screening for breast, bowel, and cervical cancer, and that the UK National Screening Committee has recommended targeted prostate screening for men carrying a genetic change that raises their risk.

That is his account. This page does not extend it. What it can do is set out why the screening question is harder than it looks.

What PSA is

Prostate-specific antigen is a protein made by prostate tissue and measured in blood. Cancer can raise it. So can an enlarged prostate, inflammation, infection, and recent procedures. Some prostate cancers occur with a low PSA.

NCI's position is unusually direct: the evidence is insufficient to determine whether screening with PSA or a digital rectal exam reduces deaths from prostate cancer. Screening finds cancer earlier, but NCI says it is not clear that finding it earlier changes the outcome. Results from randomized trials are inconsistent.

The two big trials

The European trial, ERSPC, enrolled 162,243 men aged 55 to 69 in its core group and offered PSA screening roughly every four years.

At 13 years of follow-up there were 355 prostate cancer deaths in the screened group and 545 in the control group. That works out, NCI reports, at 781 men needing to be invited for screening to prevent one prostate cancer death, and 48 men needing a biopsy. At 16 years the mortality rate ratio was 0.80 and the incidence rate ratio was 1.41 — meaning screening found 41% more cancers while preventing about one death in five.

The American trial, PLCO, randomized 76,693 men to annual PSA and rectal exam or usual care. Its problem was that usual care included a lot of screening. Self-reported PSA testing in the control group rose from 40% in year one to 52% by year six, which blunts any difference the trial could show.

The harms, in NCI's words

NCI says, on solid evidence, that screening leads to overdiagnosis: finding cancers that would never have caused a problem. That leads to overtreatment.

It also says, on solid evidence, that prostate cancer treatments including surgery and radiation cause permanent side effects in many men. Its figure is stark. Between 20% and 70% of men who had no problems beforehand will have reduced sexual function, urinary problems, or both.

Biopsies carry their own risks: fever, pain, blood in semen or urine, urinary infection, and rarely sepsis. NCI also notes psychological harm in men who have a biopsy and turn out not to have cancer. Our page on the benefits and possible harms of PSA screening works through the trade-off.

Where the guidance lands

The US Preventive Services Task Force gives PSA screening a Grade C for men aged 55 to 69, meaning the decision should be an individual one made after a discussion of benefits and harms. Its wording is worth quoting: clinicians should not screen men who do not express a preference for screening.

For men 70 and older it is a Grade D. Do not screen.

The Task Force lists what should shift the balance in an individual conversation: family history, race and ethnicity, other medical conditions, and what the person values about the possible outcomes.

The numbers that make it confusing

For 2026 the American Cancer Society projects 333,830 new US prostate cancer diagnoses and 36,320 deaths, and SEER lists those numbers. Five-year relative survival across all stages, for cases diagnosed in 2016 through 2022, is 98.2%.

By stage: localized 100.0%, regional 100.0%, distant 40.1%. About 69% are found while localized and 9% after they have spread.

That 98.2% is the number most people see, and it is the reason overdiagnosis is so hard to explain. Many of the cancers inside it were never going to cause trouble. The figure describes a group, not a person, and it says nothing about which cancers needed treating. Our page on Gleason scores and grade groups explains how the ones that matter are identified.

When to get checked

Screening is a conversation to have, not a test to demand. Reasonable prompts for that conversation:

• You are 55 to 69 and want to weigh it up
• A father or brother had prostate cancer, or you have Black ancestry, or a known BRCA change in the family
• You are under 55 with a strong family history and want to know when to start

Symptoms are a different matter and should not wait for a screening schedule. NCI lists these as reasons to check with a doctor:

• Trouble starting the flow of urine
• Frequent urination, especially at night
• Trouble emptying the bladder completely
• A weak or interrupted, stop-and-go flow of urine

For advanced disease NCI adds pain in the back, hips, or pelvis that does not go away, and the signs of anemia: breathlessness, deep tiredness, a fast heartbeat, dizziness, or pale skin.

NCI is careful to add that an enlarging prostate with age, called benign prostatic hyperplasia, causes the same urinary symptoms and is not cancer. They still need a cause found.

What this story cannot tell you

• Richard's all-clear does not define his stage, grade, treatment, or follow-up plan, and this page does not infer them.
• One person's early detection does not remove the harms of screening a whole population.
• A high PSA is not a diagnosis, and a low one is not a guarantee.
• ERSPC and PLCO ran with older protocols. MRI before biopsy, which is now common, was not part of them.
• The survival figures blend cancers that needed treating with cancers that did not.

Sources

• Associated Press, Singer Cliff Richard says he has been treated for prostate cancer — https://apnews.com/article/7d5640c6c2f7059fdfff01b99e30f4ea
• NCI PDQ, Prostate Cancer Screening (Health Professional Version) — https://www.cancer.gov/types/prostate/hp/prostate-screening-pdq
• US Preventive Services Task Force, Prostate Cancer: Screening — https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening
• NCI PDQ, Prostate Cancer Treatment (Patient Version) — https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq
• SEER Cancer Stat Facts, Prostate Cancer — https://seer.cancer.gov/statfacts/html/prost.html

How this article was prepared

An AI-assisted editorial system helped prepare this page. No named medical reviewer has reviewed it unless one is listed.

The National Cancer Information Foundation publishes Cancer Explained. This page is for learning. It is not medical advice and does not suggest a test or treatment.

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