Working-Class Men with Prostate Cancer Left Behind by NHS

Published: 13 November 2025. The English Chronicle Desk. The English Chronicle Online.

New data reveal a stark divide in prostate cancer outcomes across England, with working-class men facing significantly higher risks of death from the disease than their wealthier counterparts. While deaths from prostate cancer have fallen nationally since 2016, the improvements are disproportionately concentrated in affluent areas, highlighting a persistent inequality in healthcare access and awareness.

Experts warn that these findings underscore the urgent need for targeted screening programmes, which could ensure men at greatest risk are offered timely tests rather than relying on them to request them through routine GP visits. Men living in wealthier areas are far more likely to know that they can request a prostate-specific antigen (PSA) test, giving them an advantage in early diagnosis. Conversely, working-class men, many of whom live in more deprived communities, are at greater risk of being overlooked by the current system.

The Telegraph has long campaigned for the introduction of targeted screening, particularly for high-risk groups including men with a family history of prostate cancer and black men, who are twice as likely to develop and die from the disease. According to the latest figures from the Government’s Office for Health Improvement and Disparities (OHID), the number of deaths per 100,000 men fell from 47.72 in 2016–2018 to 43.68 in 2021–2023. While this represents an overall improvement, the gap between rich and poor areas has widened. In the most deprived regions, 45.94 deaths per 100,000 men were recorded, compared with 42 per 100,000 in the wealthiest parts of the country, a difference more than double what it was when the figures were first collected.

Professor Nick James, of The Institute of Cancer Research in London, said the data show “the impact of inequality on survival.” He explained: “With the current system as it is, middle-class men are far more likely to come forward to seek tests, and working-class men are far more likely to be left behind. There is a major inequalities issue here, which also reflects the fact that those from ethnic minorities, who have a higher risk of prostate cancer, are over-represented in deprived communities.”

David James, director of patient projects and influencing at Prostate Cancer Research, echoed the call for action. “Too often, it’s the most privileged men – those taught to push back against the system and claim what they’re entitled to – who have the best chance of surviving prostate cancer. Black men and those with a family history face the highest risks, yet under the current system, it’s men in the wealthiest areas who benefit most, not those most at risk,” he said. “We need a targeted screening programme so that neither background nor postcode determines survival – so that all men have an equal chance of early diagnosis and survival. Without action, men in the most deprived communities will continue to be left behind.”

The OHID data also illustrate geographic disparities in mortality rates. Among the local authorities with the highest prostate cancer death rates are West Lindsey in Lincolnshire (62.1 deaths per 100,000 men), Ashfield in Nottinghamshire (59.3 per 100,000), and Dartford in Kent (57.9 per 100,000). Conversely, areas with the lowest mortality include Surrey Heath (25.4 per 100,000), Barnet in north London (26.7 per 100,000), and Three Rivers in Hertfordshire (29 per 100,000).

This geographic imbalance mirrors findings published earlier this year in BMJ Oncology, which showed that men in certain regions are almost twice as likely to be diagnosed with terminal prostate cancer. Patients in Devon and Cornwall fared worst, followed by those in Yorkshire, the North East, and Cumbria. By contrast, men living in London, Kent and Medway, Dorset, Hampshire, and the Isle of Wight had the best chance of early diagnosis and survival.

The disparities are compounded by socio-economic and ethnic factors. Black men, who are at twice the risk of developing prostate cancer, are disproportionately represented in deprived communities where awareness of PSA testing is lower and access to healthcare may be more limited. Combined with cultural and social barriers to seeking medical help, this creates a situation in which the men most at risk are frequently the least likely to benefit from early detection.

Experts emphasise the importance of modern diagnostic tools in addressing these inequalities. MRI scans and other advanced imaging techniques allow clinicians to pinpoint cases requiring treatment, reducing unnecessary interventions while improving outcomes for those with aggressive disease. Yet without a system that proactively offers testing to high-risk groups, these technological advances are unlikely to reach the men who need them most.

The Department of Health and Social Care said in a statement: “Life chances should never be determined by where you live, that’s why we’re prioritising investment in areas with the greatest health needs. The UK National Screening Committee is also looking at prostate cancer screening as a priority, including reviewing the evidence for screening men with a family history of prostate cancer and other high-risk groups.”

The department added that alongside the review, it is “investing £16 million in trialling new detection approaches, and deploying cutting-edge technology to personalise medicine, catch sickness sooner, and save lives.” These investments are intended to improve early detection, treatment, and survival for all men, particularly those historically underserved by the NHS.

Prostate cancer remains one of the most common cancers among men in the UK, and timely diagnosis is key to improving survival. Experts warn that failing to address inequalities could entrench a two-tier system in which wealth, geography, and social advantage determine access to life-saving care. The evidence suggests that while mortality rates are falling overall, working-class men and men in deprived areas are not seeing the same gains as their more affluent peers.

Professor James described targeted screening as “a crucial step in addressing systemic inequalities in prostate cancer outcomes. Screening needs to be proactive, rather than relying on men to navigate the system themselves. Awareness campaigns, coupled with easy access to PSA testing and follow-up diagnostics, could significantly reduce the gap between rich and poor areas.”

David James of Prostate Cancer Research added that the lack of targeted intervention represents a moral failing. “We cannot continue to allow postcode or background to determine whether a man survives prostate cancer. Early diagnosis saves lives, and we have the tools and knowledge to act now. Ignoring these disparities condemns the most vulnerable men to poorer outcomes.”

The recent findings have prompted renewed calls from medical experts, campaigners, and patient advocacy groups for the government to implement a targeted national screening programme. While the UK National Screening Committee continues to review the evidence, advocates argue that action should not be delayed, given the clear socio-economic and ethnic disparities in mortality rates.

The stark contrast between regions such as West Lindsey and Surrey Heath illustrates the urgent need for coordinated public health interventions. By identifying men at greatest risk and offering regular PSA tests, alongside MRI follow-ups where needed, health services could close the gap and ensure all men, regardless of background, have an equal chance of early diagnosis and effective treatment.

Without a focused approach, critics warn, working-class men and those from high-risk ethnic groups will continue to lag behind, undermining the progress made in other parts of the country. The new data highlight that while the NHS has made strides in reducing overall prostate cancer mortality, a growing divide threatens to leave the most vulnerable behind.

Ultimately, experts agree that addressing the disparity in prostate cancer outcomes requires a combination of targeted screening, public awareness campaigns, and equitable access to advanced diagnostic technology. Closing the gap between affluent and deprived areas will not only save lives but also ensure that the benefits of modern medicine are shared fairly across society, rather than concentrated in the communities best equipped to navigate the healthcare system.