Why Jeremy Clarkson was well meaning but wrong

Written by Dr Clare Craig on June 30, 2026. Posted in Current News

In June 2026, Jeremy Clarkson announced that he was in remission from prostate cancer and called himself the luckiest man alive.

Clarkson, a TV personality with a global following, had an aggressive tumour that had been caught early the previous year, and a follow-up PSA test had come back clear.

He used the moment to press a message on other men via his popular Amazon Prime show, Clarkson’s Farm. Get tested, he said, and if a GP turns you away because you have no symptoms, invent some. “Just lie,” he advised, tell them you are up half the night needing to urinate. Around 12,000 men in the UK die of prostate cancer each year, he pointed out, and no man should let himself become one of them.

In practice, PSA tests are ordered on men all the time, often added to routine blood tests without discussion and without any informed consent about what an abnormal result will set in motion.

Jeremy Clarkson’s advice was heartfelt – he wanted to save lives. But the advice could lead to thousands of healthy men becoming impotent or incontinent without helping them live any longer. That is why prostate cancer screening has never been rolled out in the UK.

If every man were screened, the arithmetic would be this:

• about 1 in 100 men would die of prostate cancer whether screened or not – for them screening changes nothing;

• about 1 in 500 men would be spared a death from prostate cancer because of screening;

• yet the same number of men still die, and at the same age.

His conviction is understandable given his circumstance. However, there are many assumptions that led to his conclusion and they are not all correct.

1. PSA reliably tells you whether you have dangerous prostate cancer.
2. Finding prostate cancer early usually saves lives.
3. The benefits of treatment outweigh the harms.
4. Preventing prostate cancer deaths helps men live longer overall

Let’s take each in turn.

1. PSA reliably tells you whether you have dangerous prostate cancer. If the test is really strongly positive that is a good indicator of cancer and it is also a good test for following up cancer patients to measure how much cancer burden they have. If the test is really negative then that is a great way to reassure men. However, 28% of those screened have one or more positive tests and many men end up with a result between the two and uncertainty about what it means leading to painful interventions and potentially overdiagnosis.

PSA is not a cancer test. It is a protein produced by normal prostate cells. Levels can rise because of cancer, but also because of benign enlargement, infection, inflammation or recent ejaculation. PSA is measurable even in boys and rises naturally during puberty as the prostate develops under the influence of testosterone. Elevated PSA is therefore a signal that something may be affecting the prostate rather than proof of cancer. It is prostate-specific, but not cancer-specific.

2. Finding prostate cancer early usually saves lives. Earlier diagnosis of cancer generally does result in better outcomes. This is likely true for those prostate cancers that go on to spread but may not be true for all of them.

3. The benefits of treatment outweigh the harms. Overdiagnosis can lead to surgery, impotence and incontinence. That is the gamble here.

4. Preventing prostate cancer deaths helps men live longer overall. Screening has never been shown to impact overall mortality only prostate labelled death.

Prostate cancer is an unusual cancer. Many men die with prostate cancer rather than from prostate cancer i.e. it has no impact on their life expectancy. However, for a few they have aggressive prostate cancer which significantly reduces life expectancy. When the latter is caught while it is still confined to the gland, the risk can be reduced with surgical removal of the prostate. This comes with a significant risk of impotence and incontinence.

There are limits to how well we can predict which cancers will prove to be aggressive. The PSA test certainly cannot tell the cancers that matter from the cancers that don’t i.e. one that would never impact on the man and should be ignored. It is a bit like having a classroom of children where a number of them look “naughty”, but only a subset ever show bad behaviour. It is the behaviour that matters more than the appearance. A PSA test finds all the naughty-looking children – and some who don’t look remotely naughty – but it cannot tell you which ones will actually misbehave. The result is that many men undergo multiple biopsies. From there, a significant number go on to have surgery for cancers that would never have harmed them. As a result, men who would never have known they had prostate cancer and would die of something else end up impotent and incontinent.

The scientist who first developed the PSA test vented his frustration in The New York Times in 2010 when he said:

The test is hardly more effective than a coin toss…. it can’t distinguish between the two types of prostate cancer—the one that will kill you and the one that won’t.

— Richard J. Ablin, who discovered PSA in 1970. The Great Prostate Mistake, New York Times (2010)

In 2010, Richard J. Ablin, the research scientist who discovered prostate-specific antigen, publicly described the test’s use as a screening tool as “a hugely expensive public health disaster.” His warning remains remarkably prescient: decades of large randomised trials have since confirmed that distinguishing harmful from harmless prostate cancer remains PSA testing’s central, and largely unresolved, problem.

This is the reason the United Kingdom has never introduced a national prostate screening programme. The UK National Screening Committee has repeatedly declined to recommend one because of overdiagnosis and overtreatment.

Finding Cancer Is Not the Same as Preventing Death

The natural history of untreated prostate cancer is highly variable. Many men with prostate cancer die with it, not from it. By the time men reach their seventies and eighties, a substantial proportion harbour microscopic prostate cancers that will never cause symptoms or death.

PSA screening detects many of these slow-growing, clinically insignificant cancers. Once a man is told he has cancer, psychological pressure and medical norms create powerful incentives to treat. But treatment – prostatectomy, radiotherapy, hormone therapy – carries substantial harms, and many men end up treated for cancers that would never have progressed.

Overdiagnosis: The Central Problem

Overdiagnosis is a measured, empirical finding. Depending on the screening programme, between one in six and roughly one in two PSA-detected prostate cancers are overdiagnoses i.e. cancers that would never have caused harm if left undetected.

A reasonable central estimate, used in this article, is that approximately 42% of screen-detected prostate cancers are overdiagnosed. Some studies estimate fewer (the Canadian tool implies about one-third); repeated-screening models estimate more. Once overdiagnosed, the treatment burden falls almost entirely on men who were never destined to suffer clinically important disease.

Treatment Harms Are Substantial and Lifelong

For men treated for localised prostate cancer in the ProtecT trial (a major randomised comparison of treatment strategies, reported to 12 years):

The take home message is that after surgery:

• Around 4 in 5 lose erections sufficient for intercourse.
• Around 1 in 5 require pads because of urinary leakage.

Seven years after surgery, about four in five men reported erections insufficient for intercourse. Some men recover function during the first year after surgery, but erectile dysfunction remains common in the long term. These harms are common consequences of treatment, affecting the majority of men who undergo prostatectomy. Once incontinence or erectile dysfunction develops, it is usually permanent.

Some decline in erectile function and urinary control also occurs with ageing in men who are not treated. The figures above therefore represent the prevalence after surgery rather than the excess caused by surgery itself. Nevertheless, surgery is associated with a large and sustained increase in both problems compared with active monitoring.

The Numerical Trade-Off: What Screening Actually Delivers

The table below models 10,000 men over roughly 13–16 years. Because published estimates of overdiagnosis vary, two screened columns are shown: a lower estimate from the Canadian Task Force tool (about one-third of screen-detected cancers overdiagnosed) and a higher estimate from ERSPC Rotterdam modelling (42%). The not-screened baseline is the same in both.

Sources and method:

• Baseline of ~690 clinically meaningful cancers per 10,000 from the Canadian Task Force 1,000-person tool, scaled ×10.

• Lower estimate: Canadian Task Force tool (102 diagnosed, 33 overdiagnosed per 1,000; ~32%).

• Higher estimate: 42% overdiagnosis applied to the same baseline, from ERSPC Rotterdam modelling (Heijnsdijk).

• Surgery: roughly 30% of diagnosed men (ERSPC model). Treatment harms from ProtecT: ~80% impotent and ~25% incontinent of surgical patients.

• Mortality: ERSPC / Harding pooled estimate (10 vs 12 prostate cancer deaths per 1,000 over 16 years); no overall mortality benefit shown.

Expressed verbally:

For every 10,000 men screened, between 330 and 500 extra men are diagnosed with prostate cancer, roughly 100 to 150 extra undergo surgery, around 80 to 120 extra become impotent, and about 25 to 37 extra become incontinent. In return, about 20 prostate cancer deaths may be prevented – but no reduction in overall mortality has been demonstrated.

To prevent one prostate cancer death screening leads to approximately:

• 16 to 25 extra diagnoses
• 5 to 8 extra surgeries
• 4 to 6 extra men becoming impotent
• 1 to 2 extra men becoming incontinent

Translated into real numbers, in the UK this leaves around 1,600 men a year impotent from surgery for a cancer that would never have harmed them, and that counts surgery alone, not radiotherapy. In the United States, where screening has been far more widespread, a conservative estimate is that between 150,000 and 300,000 men are alive today and impotent for the same reason.

Mortality Outcomes: The Puzzling Disconnect

The central paradox: screening consistently reduces prostate-cancer-specific mortality in randomised trials to the tune of 0.2% of men, yet does not convincingly reduce overall mortality.

Why No Overall Mortality Benefit?

Despite consistent reductions in deaths attributed to prostate cancer, no trial has convincingly demonstrated a reduction in deaths from all causes. Several explanations have been proposed, including competing causes of death, treatment harms, and the relatively small absolute benefit of screening.

Many prostate cancer deaths that are prevented are replaced by deaths from other causes. A man whose prostate cancer would have killed him at 84 may instead die of heart disease at 84. The total death still occurs; only the cause changes. This is called competing mortality, and it is especially pronounced in older populations.

Complications from therapy may reduce life expectancy in some men, offsetting part of the mortality benefit from preventing prostate cancer deaths.

In the ERSPC data at 23 years, one prostate cancer death is prevented per 456 men invited to screening which is an absolute reduction of about 0.2%. To detect an effect that small on overall mortality requires enormous trials with decades of follow-up, and even then it is difficult to distinguish from chance.

Informed Decision-Making

Screening is not inherently good or bad. But the evidence demands transparency about what it actually delivers. Men considering PSA screening deserve to understand:

• Screening finds many more cancers than would ever have caused harm.
• Once diagnosed with cancer, psychological and medical pressure to treat is powerful.
• Treatment carries substantial risks of lifelong incontinence and erectile dysfunction.
• The reduction in prostate-cancer-specific mortality is modest (about 2 deaths prevented per 1,000 men screened).
• Overall mortality is not convincingly reduced. Screening changes diagnoses and recorded causes of death far more than it changes the number of deaths.

Conclusion

Men who are screened have not been shown to live longer overall. After decades of research, the evidence does not show that PSA screening helps men live longer overall. What it unquestionably does is diagnose many more cancers and expose many more men to serious lifelong harms. Every man deserves to know this.

Instead of recommending screening Jeremy Clarkson might want to consider campaigning against the drug folic acid – which doubles the risk of prostate cancer – being put into our white flour. You can read about the issues on that subject on our website, where a recent article includes a link to a parliamentary petition to end mandatory folic acid.

source  hartuk.substack.com

About the author:Dr Clare Craig BM BCh FRCPath is a medical doctor and is a specialist Diagnostic Pathologist from England. She is a co-chair of the HART Group. Dr Craig is a consultant pathologist who worked for many years with in the UK National Health Service (NHS) before moving to work on the cancer arm of the 100,000 Genomes Project. More recently Dr Craig has worked with a medical tech startup to develop solutions that can accelerate pathological diagnosis