Introduction
Prostate-specific antigen (PSA) testing, a common method for detecting prostate cancer, may not be effectively targeting those who would benefit most, according to researchers from the University of Oxford. Their study, published in The BMJ, analyzed data from over 10 million men across England and raised concerns about the potential for overtesting.
Current PSA Testing Practices
Despite recommendations in the UK to limit PSA testing to patients with symptoms or after consultation with a general practitioner, the study found that many patients undergo testing more frequently than advised. This includes repeat testing in individuals without recorded symptoms or with previously low PSA values.
Influence of Public Figures
The researchers noted that unpredictable surges in PSA testing could be linked to public figures sharing their cancer diagnoses and advocating for screening. Such advocacy can lead to increased testing and associated costs without clear benefits.
Prostate Cancer in the UK
Prostate cancer is the most commonly diagnosed cancer in the UK. However, routine PSA testing is recommended only for men with specific symptoms. The controversy surrounding PSA testing stems from the risk of diagnosing and treating healthy men for tumors that may not pose a threat.
Study Methodology
The study examined data from 10,235,805 men aged 18 and over, registered at 1,442 general practices across England between 2000 and 2018. None of these men had a prostate cancer diagnosis before the study. The data were linked to various national health databases and analyzed based on region, socioeconomic status, age, ethnicity, family history, symptom presentation, and PSA values.
Findings on Testing Frequency
During the study period, 1,521,116 men underwent at least one PSA test, resulting in a total of 3,835,440 tests. Testing increased five-fold, particularly among men without symptoms and those with PSA values below recommended thresholds. The highest testing rates were observed in men aged 70 and older, who are less likely to benefit from repeat testing, and in younger men aged 18–39.
Demographic Variations in Testing
Testing rates varied significantly by region, socioeconomic status, ethnicity, family history, age, PSA value, and symptoms. The highest rates were seen in white patients and those from less deprived areas. Almost half of the men tested (735,750) were retested, with over 75% having no symptoms recorded and 73% never exceeding the recommended PSA threshold.
Concerns About Retesting Intervals
The average interval between tests was just over 12 months, and 17 months for those who never exceeded the PSA threshold, which is shorter than most guidelines suggest. Retesting intervals were shorter for older patients, those from non-white ethnic groups, those with a family history of prostate cancer, or those with previously elevated PSA values.
Limitations and Robustness of the Study
The authors acknowledged limitations in using routinely collected primary care data and noted potential biases in analyzing retesting intervals. However, they emphasized that their comprehensive analysis of PSA testing and retesting intervals yielded consistent results, suggesting robustness.
Conclusion and Recommendations
The study concluded that PSA testing in primary care is varied, with many patients undergoing more frequent testing than recommended. This raises concerns about overtesting. The authors call for urgent research to establish appropriate, evidence-based PSA retesting intervals to maximize patient benefit while minimizing risks.
Editorial Insights
In a related editorial, Dr. Juan Franco and colleagues highlighted the risks of unregulated PSA testing, which could lead to significant costs and harms while failing to detect prostate cancer likely to cause symptoms and death. They welcomed the European Commission’s interest in population-based cancer screening but stressed the need for high-quality evidence from randomized trials.
Call for Improved Guidelines
The study underscores the need for better guidance from the National Institute for Health and Care Excellence (NICE), particularly for men outside the recommended age range or those with conditions unrelated to prostate cancer.
🔗 **Fuente:** https://medicalxpress.com/news/2025-10-prostate-benefit-experts.html