A large study has found that prostate cancer blood tests could result in men being over-tested, while those at risk may be missed. Researchers from the University of Oxford analysed health records of over 10 million men in England and discovered that many were receiving prostate-specific antigen (PSA) tests far more frequently than recommended. Repeat testing often occurred in patients without symptoms or those with previously low-risk results. Experts also noted that celebrities discussing their cancer diagnoses publicly have contributed to increased demand for PSA tests.
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The PSA test measures a protein produced by prostate gland cells and has long been controversial. While some argue all men should be regularly tested to detect cancer early, others point out the test’s limitations and lack of evidence in reducing deaths. PSA levels can rise for various reasons, including minor infections, and around 75% of men with raised levels do not have prostate cancer. Conversely, approximately 15% of men with normal PSA results may still have aggressive cancer, highlighting the test’s imperfect accuracy.
Current NHS guidance recommends PSA testing primarily for men with urinary tract symptoms, erectile dysfunction, or blood in the urine. Men over 50 without symptoms may request a test after consulting their GP, but widespread population screening is not advised by the UK National Screening Committee due to potential harms, costs, and uncertain impact on mortality. The study, published in the British Medical Journal, found that 1.5 million patients had at least one PSA test between 2000 and 2018, with nearly half undergoing multiple tests, often without exceeding the threshold for referral.
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The research also revealed demographic disparities: men in their 70s, white men, and those living in affluent areas were more likely to be tested. Testing rates were highest in the South East and lowest in the North East, with rates in asymptomatic men two to three times higher than in those with symptoms. Experts stressed that while some men may be under-tested, others face unnecessary repeat testing, raising concerns about overdiagnosis and associated costs. Cancer charities have called for updated, evidence-based guidelines to ensure PSA testing is both targeted and effective.
