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Present prostate particular antigen (PSA) testing “may not effectively target testing to those most likely to benefit, raising concerns about overtesting” warn researchers from the College of Oxford in a examine of over 10 million males throughout England printed by The BMJ .
Regardless of UK suggestions to restrict PSA testing to sufferers with signs or after dialogue with a GP, the outcomes present that many sufferers are examined extra often than advisable and repeat testing is happening in sufferers with out recorded signs or with earlier low PSA values.
The authors say the findings mirror an absence of constant worldwide steerage and word that “unpredictable surges in PSA testing, overtesting, and associated costs” might happen on account of celebrities publicly sharing their most cancers diagnoses and advocating for screening.
Prostate most cancers is probably the most generally identified most cancers within the UK, however PSA testing is just routinely advisable for males with sure signs. PSA testing usually stays controversial as a result of it has led to an elevated variety of wholesome males being identified and handled unnecessarily for innocent tumors.
Researchers due to this fact wished to higher perceive how PSA exams are utilized in major care in England earlier than prostate most cancers is identified.
To do that, they drew on information for 10,235,805 males aged 18 and over who have been registered at 1,442 common practices throughout England between 2000 and 2018 and didn’t have a prostate most cancers analysis earlier than coming into the examine.
Knowledge have been linked to the Nationwide Most cancers Registry, Hospital Episode Statistics, and Workplace for Nationwide Statistics and outcomes have been analyzed by area, deprivation, age, ethnicity, household historical past of prostate most cancers, symptom presentation, and PSA worth.
A complete of 1,521,116 males had not less than one PSA take a look at in the course of the examine interval, leading to 3,835,440 PSA exams general.
Testing elevated five-fold in the course of the examine interval, notably in males with out signs and people with PSA values under advisable thresholds.
The very best testing charges occurred in males aged 70 and older, who’re least prone to profit from repeat testing, and a considerable portion occurred in males a lot youthful (18–39 years) than advisable.
Testing charges diversified by area, deprivation, ethnicity, household historical past, age, PSA worth, and signs, with the very best charges seen in sufferers of white ethnicity and in much less disadvantaged areas.
Virtually half of males (735,750) have been retested. Of those, greater than 75% had no signs recorded and 73% by no means had a PSA worth above the advisable threshold.
The typical interval between exams was simply over 12 months general and 17 months for sufferers who by no means had a PSA worth above the advisable threshold (shorter than most pointers advise). As soon as examined, sufferers had shorter retesting intervals in the event that they have been older, belonged to any ethnic group apart from white, had a household historical past of prostate most cancers, or had a beforehand raised PSA worth.
The authors acknowledge that utilizing routinely collected major care information has limitations, and that analyses of retesting intervals have been restricted to sufferers with not less than two PSA exams throughout follow-up, elevating the opportunity of bias. Nevertheless, they are saying they comprehensively analyzed PSA testing and size of retesting intervals, and outcomes have been constant after additional analyses, suggesting they’re sturdy.
As such, they conclude, “PSA testing in primary care is varied. Among patients who underwent multiple tests, many were tested more frequently than recommended, raising concerns about overtesting. PSA retesting is occurring in patients without recorded symptoms or with previous low PSA values.”
“To ensure maximum patient benefit while reducing the risk of overtesting, research is urgently needed to determine appropriate evidence-based PSA retesting intervals,” they add.
The main concern raised on this examine and comparable research “is that unregulated PSA testing will result in large costs and harms and increase the incidence of prostate cancer likely to remain undetected, while doing little to identify prostate cancer most likely to cause symptoms and death,” says Dr. Juan Franco and colleagues in a linked editorial.
They welcome the European Fee’s curiosity in population-based most cancers screening, together with prostate most cancers, however say efforts want grounding in high-quality proof gleaned from randomized trials.
This examine “highlights the need for better NICE guidance, especially in men outside of the recommended ages or men with lower urinary tract symptoms, erectile dysfunction, or other conditions unrelated to prostate cancer,” they conclude.
Extra info:
Prostate particular antigen retesting intervals and developments in England: inhabitants based mostly cohort examine, The BMJ (2025). DOI: 10.1136/bmj-2024-083800
Editorial The BMJ (2025).
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British Medical Journal
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Prostate testing might not goal these most definitely to profit, warn specialists (2025, October 8)
retrieved 8 October 2025
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