Who really needs the PSA test?

The current evidence of prostate specific antigen (PSA) “may not target testing effectively to those most likely to benefit, which raises concerns about potential for over-testing“warn researchers from the University of Oxford (United Kingdom), in a study of more than 10 million men throughout England published by ‘The BMJ’.

Despite the United Kingdom’s recommendations to limit PSA testing to patients with symptoms or after discussing it with a GP, the results show that many patients are tested more frequently than recommended and repeated tests are performed on patients without symptoms registered or with previous low PSA values. The authors note that the findings reflect a lack of consistent international orientation and they point out that “unpredictable increases in PSA testing, over-testing and associated costs may occur” as a result of celebrities publicly sharing their cancer diagnoses and advocating for screening.

He prostate cancer It is the most commonly diagnosed cancer in the UK, but PSA testing is only routinely recommended for men with certain symptoms. The PSA test generally remains controversial because has caused an increasing number of healthy men to be diagnosed and treated unnecessarily by harmless tumors. Therefore, the researchers wanted better understand how PSA tests are used in primary care in England before being diagnosed with prostate cancer. To do this, they were based on data from 10,235,805 men aged 18 or older who were registered in 1,442 general practices across England between 2000 and 2018 and did not have a diagnosis of prostate cancer before entering the study.

Data reveals excess in PSA testing

The data was linked to the National Cancer RegistryHospital Episode Statistics and the Office for National Statistics, and results were analyzed by region, deprivation, age, ethnicity, family history of prostate cancer, symptom presentation and PSA value. A total of 1,521,116 men had at least one PSA test during the study periodwhich resulted a total of 3,835,440 PSA tests. Testing increased fivefold during the study period, especially in men without symptoms and in those with PSA values ​​below recommended thresholds.

The highest testing rates were in men 70 years and olderwho are least likely to benefit from repeated testing, and a substantial portion occurred in much younger men (18-39 years) than recommended. Furthermore, testing rates varied by region, deprivation, ethnicity, family history, age, PSA value, and symptoms; the highest rates were seen in patients of white ethnicity and in less deprived areas.

Almost half of the men (735,750) underwent a new test. Of these, more than 75% had no symptoms and 73% never had a PSA value higher than the recommended threshold. The average interval between tests was just over 12 months overall and 17 months for patients who had never had a PSA value above the recommended threshold (shorter than most guidelines recommend). Once the tests have been carried out, patients had shorter repetition intervals if they were olderwere of an ethnic group other than white, had a family history of prostate cancer, or had previously had an elevated PSA value.

The need for more research

The authors acknowledge that Routine use of primary care data has limitationsand Analyzes of intervals between tests were limited to patients with at least two PSA tests during follow-up, which raises the possibility of bias. However, they say they thoroughly looked at PSA testing and the length of intervals between tests, and that The results were consistent after subsequent analyses, suggesting their robustness..

Therefore, they conclude: “PSA testing in primary care is varied. Among patients who underwent multiple tests, many were performed more frequently than recommendedraising concerns about the possibility of excessive testing. New PSA tests are being performed on patients with no recorded symptoms or with previously low PSA values. For ensure maximum benefit for the patient while reducing the risk of over-testing, research is urgently needed to determine appropriate evidence-based PSA retest intervals,” the researchers add.