Prostate cancer is now the most commonly diagnosed cancer among men in the United Kingdom. Because of this, many people hope that early testing can help save lives.
One of the most widely used tools is the prostate specific antigen test, also called the PSA test. This blood test measures the level of PSA, a protein made by the prostate gland.
Higher PSA levels can sometimes be linked to prostate cancer, but they can also be caused by other common conditions such as infections, inflammation, or an enlarged prostate. This has made the PSA test both useful and controversial for many years.
Now, a large new study from the University of Oxford suggests that PSA testing in England may not be used in the best or safest way.
The researchers found that many men are being tested too often, even when they are unlikely to benefit from repeated testing. At the same time, some people who may face a higher risk of dangerous prostate cancer may not be receiving the attention they need.
The research was published in The BMJ, also known as the British Medical Journal. Scientists examined medical records from more than 10 million men in England between the years 2000 and 2018.
None of the men had prostate cancer when the study began. The team wanted to understand how PSA testing was being used in real life across the country.
The results showed a huge increase in testing over the 18-year period. PSA testing rose about five times higher than it had been at the start of the study. Around 1.5 million men received at least one PSA test during that time. Nearly half of those men later had more tests.
The researchers found that many of these repeat tests happened even when men did not have symptoms or warning signs. More than three-quarters of the men who were retested had no symptoms recorded in their medical files.
In addition, almost three-quarters never had a PSA level high enough to normally require more testing according to current medical guidance.
The average gap between tests was about one year. However, many medical guidelines suggest that men with low PSA levels may not need testing so frequently. This means many men may have been receiving unnecessary tests.
One important reason for concern is that PSA testing is not a perfect tool for finding dangerous cancer. Some prostate cancers grow very slowly and may never cause serious illness during a man’s lifetime.
However, once these harmless tumors are discovered, many patients feel pressure to undergo treatment. Treatments for prostate cancer can sometimes cause serious side effects, including problems with urination, bowel function, and sexual health. As a result, some men may suffer harm from treatment that they never truly needed.
The Oxford study also found that testing was especially common among men aged 70 and older. Experts say these older men are often less likely to benefit from repeated PSA testing because many prostate cancers grow slowly. In some cases, older men may die from other health problems long before a prostate tumor would become dangerous.
At the same time, researchers were surprised to discover that some very young men were also being tested. A small number of men as young as 18 had PSA tests, even though routine testing is generally not recommended for young adults without symptoms.
The study also showed differences between social groups. White men and men living in wealthier areas were more likely to receive PSA testing. Family history and ethnicity also appeared to influence testing rates. These findings suggest that access to testing and medical decisions may not be equal across all communities.
In the UK, PSA testing is not part of a national screening program like breast cancer or bowel cancer screening. Instead, doctors usually offer the test to men with symptoms or after discussing the possible risks and benefits with a general practitioner.
This is partly because experts still disagree about how useful PSA screening really is for the general population.
The researchers warned that PSA testing can sometimes increase suddenly after famous public figures announce they have cancer.
These celebrity stories may encourage many healthy men to request testing even when there is little evidence that it will help them. Such sudden increases may place extra pressure on healthcare systems while also leading to unnecessary anxiety and medical treatment.
Experts who wrote an editorial linked to the study said uncontrolled PSA testing could create major costs for health services while offering limited benefits. They believe more large clinical trials are needed to better understand who truly benefits from testing and how often tests should be repeated.
The Oxford researchers concluded that PSA testing in England is currently being used too often in many men who are unlikely to benefit. Meanwhile, people at higher risk may not always be properly targeted.
The team called for urgent new research to identify safer and more effective testing schedules. They also said health authorities should provide clearer guidance to reduce confusion among both doctors and patients.
Scientists continue to search for better ways to detect dangerous prostate cancer early while avoiding unnecessary harm. Until stronger evidence becomes available, experts say men should carefully discuss the risks and possible benefits of PSA testing with their doctors before deciding whether to take the test.
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