Prostate cancer is the most commonly diagnosed cancer in the UK, and many men turn to prostate specific antigen (PSA) tests in hopes of catching it early.
But a new study from the University of Oxford suggests that PSA testing is not being used in the most effective way, raising concerns about unnecessary testing, wasted resources, and potential harm to patients.
The research, published in The BMJ, looked at data from more than 10 million men across England between 2000 and 2018.
None of the men studied had been diagnosed with prostate cancer at the start.
The findings revealed that PSA testing increased five-fold during that period, and many men were tested more often than guidelines recommend—especially men without symptoms or with previously low PSA levels.
In the UK, PSA testing is not part of routine screening. Instead, it is generally offered to men with specific symptoms or after discussion with a GP.
The test itself is controversial because it can lead to the detection of harmless tumors that may never have caused illness. As a result, many healthy men end up undergoing treatments that they do not need.
The Oxford study found that testing was especially common among older men, aged 70 and above, who are least likely to benefit from repeat testing.
Surprisingly, a significant number of men much younger than the recommended age range—some as young as 18—were also being tested. Testing rates varied by region, ethnicity, family history, and socioeconomic status, with white men and those in less deprived areas more likely to be tested.
Of the 1.5 million men who had at least one PSA test, nearly half went on to be retested. Strikingly, more than three-quarters of these men had no symptoms recorded, and almost three-quarters never had a PSA reading above the threshold that would normally justify further testing.
The average time between tests was about 12 months, shorter than most clinical guidelines suggest.
The researchers say this pattern points to inconsistent use of PSA testing and highlights the lack of clear international guidance.
They also warn that “unpredictable surges” in testing sometimes follow celebrity cancer announcements, adding further strain to the system without clear evidence of benefit.
Experts writing in a linked editorial caution that unregulated PSA testing could lead to large costs and harms while doing little to identify cancers that are truly dangerous.
They argue that better evidence is needed from large randomized trials before expanding testing programs.
The study authors conclude that PSA testing in England is being carried out too often in men unlikely to benefit, while those at higher risk may not be adequately targeted.
They call for urgent research into safe and effective retesting intervals, along with stronger guidance from health authorities to ensure that testing brings real benefits rather than unnecessary worry and overtreatment.
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Source: British Medical Journal.
