Researchers warn doctors could be ‘overtesting’ for prostate cancer
Doctors are “overtesting” men for prostate cancer and failing to target those “most likely to benefit”, researchers have warned.
Prostate cancer is the most commonly diagnosed cancer, affecting 55,300 men a year in the UK, but prostate specific antigen testing (PSA) is only routinely recommended for men with certain symptoms.
According to Prostate Cancer UK, such testing remains controversial because it has led to more healthy men being unnecessarily diagnosed and treated for harmless tumors that can lead to erectile dysfunction or urinary incontinence.
Researchers at Oxford University aimed to find out how PSA tests are used in their study of more than 10 million men in England.
The study, published by the BMJ, highlights that there is a lack of consistent guidance and that many patients, even those with no recorded symptoms, are tested more frequently than recommended.
The major concern expressed in this study is that “unregulated PSA testing would lead to major costs and harms and would likely increase cases of undetected prostate cancer, while doing little to identify the prostate cancer most likely to cause symptoms and death.”
Study author Dr. Juan Franco and colleagues also note that “unpredictable increases in PSA testing, overtesting, and associated costs” may increase as celebrities publicly share their cancer diagnoses and advocate for screening.
The study comes as the government awaits advice on a national screening program for prostate cancer, launched after Sir Chris Hoy called for more men to be screened after revealing he had been diagnosed with stage four prostate cancer in February 2024.
The researchers used data from 10,235,805 men aged 18 and over who were registered with 1,442 general practices across England between 2000 and 2018 and had not been diagnosed with prostate cancer before entering the study.
Data were compared with the National Cancer Registry, Hospital Episode Statistics and Office for National Statistics, and results were analyzed by region, deprivation, age, ethnicity, family history of prostate cancer, symptom presentation and PSA value.
A total of 1,521,116 men had at least one PSA test during the study period, resulting in 3,835,440 total PSA tests.
The number of tests increased fivefold during the study period, especially in men without symptoms and those with PSA values below recommended thresholds.
The highest testing rates occurred in men ages 70 and older, who are least likely to benefit from retesting, and a significant portion occurred in men decades younger than recommended.
The highest testing rates were seen in white patients in less deprived areas.
Almost half of the men (735,750) were retested. More than 75 percent of them had no symptoms recorded, and 73 percent had their PSA value never rise above the recommended threshold.
The average interval between tests was generally just over a year; For patients whose PSA value was never above the recommended threshold, this period increased to 17 months; this period is still shorter than the guidelines recommend.
Overtesting can be a problem because around a quarter of men diagnosed with prostate cancer will have a form of cancer that is slow-growing, unlikely to progress and cause harm, and therefore does not need treatment.
NICE guidance currently only recommends active surveillance as the preferred approach for men with the lowest risk cancer. But these guidelines have not been updated since 2021, and testing has improved since then.
The researchers concluded that “better NICE guidance is needed, particularly in men outside the recommended ages or with lower urinary tract symptoms, erectile dysfunction or other conditions unrelated to prostate cancer.”
A NICE spokesperson said: “We are determined to ensure that our guidelines continue to reflect the best available evidence and deliver the best possible outcomes for patients. “They are developed by an independent committee, including NHS clinical experts, and are kept under review to ensure they remain up to date.
“We will update our prostate cancer guidance, including reviewing recommendations on active surveillance, and consider whether our suspected cancer guidance around age-related thresholds for PSA tests for prostate cancer in primary care needs to be updated.”
