Prostate-specific antigen (PSA) blood tests, used for detecting prostate cancer, have come under scrutiny following a new study revealing widespread over-testing. Researchers from the University of Oxford analyzed health records of over 10 million men in England and found that many patients are undergoing PSA tests far more often than recommended. The study highlights the risks of excessive testing, which can lead to unnecessary procedures, while also pointing out the potential for missing aggressive cancer cases.
Frequent Testing Raises Alarm
According to the findings, nearly half of the 1.5 million men tested between 2000 and 2018 had multiple PSA tests, with many of them never reaching the threshold that would typically trigger further investigation. Despite having low-risk profiles, these patients were subjected to frequent tests beyond recommended guidelines. Alarmingly, testing rates were found to be higher in affluent areas, with men in the South East more likely to be tested than those in other regions, such as the North East.
The study also observed a disturbing trend where testing was more common among older men, particularly those in their 70s, and was twice as frequent in wealthier populations compared to the most deprived. In addition, the research revealed that men without symptoms were being tested at much higher rates than those who displayed risk factors such as urinary issues or erectile dysfunction. Overall, those without symptoms were tested two to three times more than those with symptoms.
Debate Over PSA Test’s Effectiveness
The PSA test, which measures a protein produced by the prostate gland, is controversial. Critics argue that it lacks reliability and has not been shown to significantly reduce prostate cancer deaths. PSA levels can rise due to many factors, including infections, meaning that most men with elevated PSA results do not have prostate cancer. The test can lead to unnecessary biopsies or treatments for cancers that may not cause harm, while also missing aggressive cases, as roughly 15% of men with a normal PSA result may still have prostate cancer.
Despite these limitations, the popularity of PSA testing has surged, partly due to high-profile celebrities like broadcaster Stephen Fry and Olympic cyclist Sir Chris Hoy publicly discussing their prostate cancer diagnoses. This has led to increased public demand for the test, which experts warn could further fuel over-testing, driving up healthcare costs without clear benefits.
The UK’s National Screening Committee does not support population-wide PSA screening, citing concerns over the test’s accuracy and the risk of over-diagnosis. Current NHS guidelines recommend the test for men over 50 who show symptoms, or for those without symptoms who consult their GP. However, many men continue to seek tests even when they are not medically indicated, adding to the growing concern that the benefits of frequent re-testing have not been proven.
Experts are calling for more research to better define testing intervals that strike a balance between early detection and the risks of over-diagnosis. Naser Turabi, director of evidence at Cancer Research UK, emphasized the need for more reliable diagnostic tools, as prostate cancer remains the second-leading cause of cancer death among men in the UK, claiming around 12,200 lives each year.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, added that this study highlights significant disparities in PSA testing across different socio-economic groups. She also called for an urgent update to the outdated guidelines, arguing that confusion surrounding the testing process is contributing to inequalities in diagnosis and treatment.
