Prostate cancer is now the most commonly diagnosed cancer in the United Kingdom.
Because early detection is often linked to better treatment outcomes, many men choose to have a blood test called the prostate specific antigen test, or PSA test, to check for possible signs of the disease.
But a large new study from the University of Oxford suggests that PSA testing may not always be used in the best or safest way. Researchers warn that many men are being tested too often, even when they are unlikely to benefit.
This could lead to unnecessary worry, extra medical procedures, wasted healthcare resources, and treatment for cancers that may never have caused harm.
The study was published in The BMJ and examined health records from more than 10 million men in England between the years 2000 and 2018. None of the men had prostate cancer at the beginning of the study.
Researchers found that PSA testing increased dramatically over the 18-year period. In fact, testing rates rose five-fold. The team discovered that many men were repeatedly tested more often than most clinical guidelines recommend.
The PSA test measures the amount of a protein produced by the prostate gland in the blood. Higher PSA levels can sometimes be linked to prostate cancer, but elevated levels can also happen for many other reasons, including aging, infections, or non-cancerous enlargement of the prostate.
Because of this, PSA testing has been controversial for many years. While the test may help detect some dangerous cancers early, it can also identify very slow-growing tumors that might never become life-threatening.
Some men who discover these harmless tumors go on to receive treatments such as surgery or radiation therapy that they may not actually need.
These treatments can sometimes cause major side effects, including urinary problems, bowel issues, and sexual dysfunction. This is one reason why many countries, including the UK, do not currently recommend routine nationwide PSA screening for all men.
Instead, in the UK, PSA testing is usually offered after a discussion between a patient and their general practitioner, especially if the man has symptoms, a family history of prostate cancer, or other risk factors.
The Oxford study found several surprising trends in how PSA testing is being used in real life. One of the biggest concerns involved older men aged 70 and above.
Researchers found that these men were among the most frequently tested, even though they are generally less likely to benefit from repeated screening because prostate cancers in older adults are often slow-growing.
At the same time, researchers discovered that many younger men were also receiving PSA tests, including some as young as 18 years old. This was unexpected because prostate cancer is extremely rare in young adults.
The study also showed differences in testing rates depending on ethnicity, region, social background, and family history. White men and men living in less deprived areas were more likely to receive testing compared with some other groups.
Among the 1.5 million men who had at least one PSA test, nearly half later received repeat testing. However, the researchers found that more than three-quarters of these men had no recorded symptoms that would normally justify repeat screening.
Even more striking, almost three-quarters of the men who were retested never had PSA levels high enough to cross the threshold that would normally raise concern for prostate cancer.
The average gap between tests was around 12 months, which researchers say is shorter than what most clinical guidelines suggest. This pattern raised concerns that many men may be receiving repeated testing without strong medical reasons.
Researchers also pointed out that PSA testing rates sometimes rise sharply after public announcements by celebrities who reveal they have prostate cancer. Scientists warn that these sudden surges in testing may place extra strain on healthcare systems without clear evidence that they improve long-term health outcomes.
Experts who wrote an editorial linked to the study said that uncontrolled PSA testing could cause large healthcare costs and expose men to unnecessary risks while failing to properly target the cancers that are truly dangerous.
They argued that more evidence is needed from large randomized clinical trials before expanding testing programs further. Researchers say better guidelines are urgently needed to help doctors decide who should be tested, how often testing should happen, and which patients are most likely to benefit.
The study authors concluded that PSA testing in England is currently being used inconsistently. Some men at low risk appear to be tested too frequently, while some higher-risk individuals may not be targeted effectively enough.
Scientists hope future research will help create smarter and safer prostate cancer screening strategies. The goal is to find dangerous cancers early while avoiding unnecessary fear, overdiagnosis, and overtreatment for men who are unlikely to benefit.
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The study was published in The BMJ.
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