Many Men Receive Frequent Prostate Cancer Tests Without Symptoms

Current prostate circumstantial antigen (PSA) testing "may not efficaciously target testing to those astir apt to benefit, raising concerns astir overtesting" pass researchers from nan University of Oxford successful a study of complete 10 cardinal men crossed England published by The BMJ today.

Despite UK recommendations to limit PSA testing to patients pinch symptoms aliases aft chat pinch a GP, nan results show that galore patients are tested much often than recommended and repetition testing is occurring successful patients without recorded symptoms aliases pinch erstwhile debased PSA values.

The authors opportunity nan findings bespeak a deficiency of accordant world guidance and statement that "unpredictable surges successful PSA testing, overtesting, and associated costs" whitethorn hap arsenic a consequence of celebrities publically sharing their crab diagnoses and advocating for screening.

Prostate crab is nan astir commonly diagnosed crab successful nan UK, but PSA testing is only routinely recommended for men pinch definite symptoms. PSA testing mostly remains arguable because it has led to an accrued number of patient men being diagnosed and treated unnecessarily for harmless tumours.

Researchers truthful wanted to amended understand really PSA tests are utilized successful superior attraction successful England earlier prostate crab is diagnosed.

To do this, they drew connected information for 10,235,805 men aged 18 and complete who were registered astatine 1,442 wide practices crossed England betwixt 2000 and 2018 and did not person a prostate crab test earlier entering nan study.

Data were linked to nan National Cancer Registry, Hospital Episode Statistics, and Office for National Statistics and results were analysed by region, deprivation, age, ethnicity, family history of prostate cancer, denotation presentation, and PSA value.

A full of 1,521,116 men had astatine slightest 1 PSA trial during nan study period, resulting successful 3,835,440 PSA tests overall. 

Testing accrued fivefold during nan study period, peculiarly successful men without symptoms and those pinch PSA values beneath recommended thresholds. 

The highest testing rates occurred successful men aged 70 and older, who are slightest apt to use from repetition testing, and a important information occurred successful men overmuch younger (18-39 years) than recommended.

Testing rates varied by region, deprivation, ethnicity, family history, age, PSA value, and symptoms, pinch highest rates seen successful patients of achromatic ethnicity and successful little deprived areas.

Almost half of men (735,750) were retested. Of these, much than 75% had nary symptoms recorded and 73% ne'er had a PSA worth supra nan recommended threshold.

The mean interval betwixt tests was conscionable complete 12 months wide and 17 months for patients who ne'er had a PSA worth supra nan recommended period (shorter than astir guidelines advise). Once tested, patients had shorter retesting intervals if they were older, belonged to immoderate taste group different than white, had a family history of prostate cancer, aliases had a antecedently raised PSA value.

The authors admit that utilizing routinely collected superior attraction information has limitations, and that analyses of retesting intervals were constricted to patients pinch astatine slightest 2 PSA tests during follow-up, raising nan anticipation of bias. However, they opportunity they comprehensively analysed PSA testing and magnitude of retesting intervals, and results were accordant aft further analyses, suggesting they are robust.

As such, they conclude: "PSA testing successful superior attraction is varied. Among patients who underwent aggregate tests, galore were tested much often than recommended, raising concerns astir overtesting. PSA retesting is occurring successful patients without recorded symptoms aliases pinch erstwhile debased PSA values."

"To guarantee maximum diligent use while reducing nan consequence of overtesting, investigation is urgently needed to find due grounds based PSA retesting intervals," they add.

The awesome interest raised successful this study and akin studies "is that unregulated PSA testing will consequence successful ample costs and harms and summation nan incidence of prostate crab apt to stay undetected, while doing small to place prostate crab astir apt to origin symptoms and death," opportunity Dr Juan Franco and colleagues successful a linked editorial.

They invited nan European Commission's liking successful organization based crab screening including prostate cancer, but opportunity efforts request grounding successful precocious value grounds gleaned from randomised trials.

This study "highlights nan request for amended NICE guidance, particularly successful men extracurricular of recommended ages aliases men pinch little urinary tract symptoms, erectile dysfunction, aliases different conditions unrelated to prostate cancer," they conclude.