Unwarranted PSA tests leading to over-testing and unnecessary treatment

Surge in demand for prostate specific antigen (PSA) testing, prompted by celebrity endorsement, is leading to increased numbers of healthy men being diagnosed and treat unnecessarily for harmless tumours

Current PSA testing ‘may not effectively target testing to those most likely to benefit, raising concerns about over-testing’ warn researchers from the University of Oxford in a study of over 10 million men across England in The BMJ.

Despite UK recommendations to limit PSA testing to patients with symptoms or after discussion with a GP, the results show that many patients are tested more frequently than recommended and repeat testing is occurring in patients without recorded symptoms or with previous low PSA values.

The authors say the findings reflect a lack of consistent international guidance and note that ‘unpredictable surges in PSA testing, overtesting, and associated costs’ may occur as a result of celebrities publicly sharing their cancer diagnoses and advocating for screening.

Prostate cancer is the most commonly diagnosed cancer in the UK, but PSA testing is only routinely recommended for men with certain symptoms. PSA testing generally remains controversial because it has led to an increased number of healthy men being diagnosed and treated unnecessarily for harmless tumours.

Researchers examined data for 10,235,805 men aged 18 and over, registered with 1,442 general practices across England between 2000 and 2018, and who did not have a prostate cancer diagnosis before entering the study.

A total of 1,521,116 men had at least one PSA test during the study period, resulting in 3,835,440 PSA tests overall.

Testing increased fivefold during the study period, particularly in men without symptoms and those with PSA values below recommended thresholds.

The highest testing rates occurred in men aged 70 and older, who are least likely to benefit from repeat testing, and a substantial portion occurred in men much younger (18-39 years) than recommended.

As such, they conclude: ‘PSA testing in primary care is varied. Among patients who underwent multiple tests, many were tested more frequently than recommended, raising concerns about overtesting’.

The study ‘highlights the need for better NICE guidance, especially in men outside of recommended ages or men with lower urinary tract symptoms, erectile dysfunction, or other conditions unrelated to prostate cancer,’ the authors conclude.

Collins K, et al. BMJ 2025;391:e083800. https://www.bmj.com/content/391/bmj-2024-083800