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A large study has found that prostate cancer blood tests may be causing men to be over-tested, while missing those who need help.
Researchers at the University of Oxford examined the health records of more than 10 million men in England and found that many patients were being given prostate specific antigen (PSA) tests much more often than recommended.
According to the study, even those patients who are asymptomatic or whose previous tests suggest a low level of risk are undergoing frequent testing.
Experts also said that celebrities are sharing their cancer journeys and advocating for PSA The number of tests is increasing due to the increase in requests for testing.
The PSA test, which measures the amount of protein produced by prostate gland cells, has proven controversial, with some saying all men should be tested at regular intervals to detect cancer, while others arguing that the test is unreliable and has not been shown to reduce deaths.
Proof There are suggestions that PSA levels can increase for a variety of reasons, including simple infections, and 75% of people with an elevated PSA do not have prostate cancer.
Elevated levels mean men may be sent for unnecessary biopsies or MRIs, or treated for tumors that could never cause harm.
PSA testing may also miss invasive cancers. Evidence suggests that about 15% of people with normal results may actually have prostate cancer.
Current NHS guidance recommends that PSA testing be considered for patients with urinary tract symptoms, erectile dysfunction, or blood in their urine.
men People over 50 without symptoms can also request a PSA test after consultation with their GP.
The UK National Screening Committee does not recommend widespread population screening due to limitations in the accuracy of the test and its potential harms, as well as a lack of evidence that it reduces prostate cancer deaths.
In the latest study, published in the British Medical Journal (BM), nearly 1.5 million patients had at least one PSA test between 2000 and 2018, resulting in a total of 3.8 million PSA tests.
About 48.4% (735,750) of these patients had multiple tests, of which 72.8% (535,990) never had a PSA value above the point at which they would normally be referred for testing.
The researchers also noted that patients over the age of 70 were more likely to be tested than younger men, and testing rates were higher for white men.
Testing rates were also highest in the South East and lowest in the North East and were more than double in the least deprived groups compared to the most deprived groups.
Overall, testing rates were two to three times higher among asymptomatic patients than among symptomatic patients.
The researchers said: “Although many patients were never tested, which suggests that under-testing is possible, others were tested only once, which may be inadequate for those at risk.
“We also identified a group of patients with low PSA values who consistently underwent testing beyond guideline recommendations, raising concerns about over-testing.
“The benefit of retesting and ad hoc screening remains uncertain and further research is needed to determine evidence-based retesting intervals that balance the benefits of early detection with the harms of overdiagnosis.”
The authors said that celebrities publicly sharing their cancer diagnoses could result in an “unexpected increase in PSA testing, over-testing, and associated costs.”
Celebrities including broadcaster Stephen Fry and Olympic cyclist Sir chris hoy Talked about his prostate cancer and the need to get checked.
In the linked BMJ editorial, doctors said there was a risk that “unregulated PSA testing will result in huge costs and harms and increase the incidence of prostate cancer that will go undetected, while making little effort to identify prostate cancer that is likely to result in symptoms and death.”
Nasser Turabi, director of evidence at Cancer Research UK, said: “Prostate cancer is the second leading cause of cancer death in men in the UK, claiming around 12,200 lives each year.
“Although we have seen breakthroughs in treatment, more research is needed to improve how we diagnose the disease.
“As this study shows, detecting aggressive forms of prostate cancer is complex, and the current PSA test is not reliable enough.
“Cancer Research UK continues to fund research into ways we can detect prostate cancer earlier and save more lives.
“We welcome efforts to ensure that testing is targeted, effective, and based on strong evidence.”
Amy Rylance, Assistant Director of Health Improvement prostate cancer UK said: “This BMJ study provides further evidence that huge inequalities and confusing guidance in PSA testing make it difficult for men and their GPs to know how to get tested for prostate cancer.
“Despite this, many men are still getting tested – but they are getting them unevenly. Some are tested more often than necessary, while others are not tested until it is too late.
“The main finding of this study is that men in the affluent South are being tested more frequently.
“But this needs to be seen in the context of other research which shows that men in wealthier areas are also more likely to be diagnosed early, before the cancer has spread.
“We are therefore calling on the government to urgently update the current guidelines, which are dangerously out of date and create confusion for men and their physicians.”