Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Study of 10 million men finds many are having prostate cancer tests more frequently than recommended. Research published in The BMJ reveals significant variations in PSA testing across England, raising concerns about overtesting.

New research lead by Oxford Cancer DPhil in Cancer Science student reveals significant variations in how prostate specific antigen (PSA) tests are used in English primary care, with many men being tested more frequently than recommended.

“PSA testing in primary care is varied,” says Kiana Collins, DPhil student and lead author based in the Nuffield Department of Primary Care Health Sciences. “Among patients who underwent multiple tests, many were tested more frequently than recommended, raising concerns about overtesting. PSA retesting is occurring in patients without recorded symptoms or with previous low PSA values.”

The study, published in The BMJ, analysed data from over 10 million men registered at GP practices across England between 2000 and 2018. The findings raise important questions about how PSA testing is being used and whether current approaches effectively target those most likely to benefit.

Almost half of those tested were retested at least once, yet more than 70% never had a PSA value above the age-specific threshold that would typically prompt a referral to specialist care. The median time between tests was around 12.5 months – shorter than most international guidance recommends, and much shorter than would be expected for lower-risk men.

Testing rates were highest in men aged 70 and older – a group least likely to benefit from repeat testing and most at risk of overdiagnosis. Researchers estimate that men in this age group account for around 40% of prostate cancer overdiagnoses.

Regional and demographic variations

Testing rates also varied by region, deprivation, and ethnicity. Rates were highest in the south east of England and lowest in the north east. Men living in the most deprived areas were tested less frequently than those in the least deprived areas, while men of white ethnicity were more likely to be tested than men from other ethnic groups.

Despite this, the length of time between repeat tests remained relatively similar across regions and deprivation groups, suggesting widespread inconsistency in how often men are retested.

The context: a controversial test

PSA testing remains controversial because, while it can help detect prostate cancer, it has also led to many healthy men being diagnosed and treated unnecessarily for slow-growing tumours that would never have caused harm. The UK National Screening Committee does not recommend routine PSA screening for this reason.

Current NHS guidance advises PSA testing for men with specific symptoms or after informed discussion with a GP, but provides no clear recommendations on how often men should be retested or at what age testing should stop.

Celebrity influence on testing patterns

The research also identified a surge in testing between 2017 and 2018, following public announcements of prostate cancer diagnoses by broadcaster Bill Turnbull and actor Stephen Fry. PSA testing increased by 26% for men without symptoms and 20% for those with symptoms during this period.

“These findings suggest that health systems should anticipate unpredictable surges in PSA testing, overtesting, and associated costs during periods of high-profile media attention,” the authors write.

What happens next?

The research team, led by Collins with colleagues Jason OkePradeep VirdeeRafael Perera, and Brian Nicholson, emphasises the urgent need “to ensure maximum patient benefit while reducing the risk of overtesting, research is urgently needed to determine appropriate evidence-based PSA retesting intervals,” they conclude.

___

The study was funded by Cancer Research UK and used data from the Clinical Practice Research Datalink linked to national cancer registries and hospital statistics.

Read the full paper: Collins KK, Oke JL, Virdee PS, Perera R, Nicholson BD. Prostate specific antigen retesting intervals and trends in England: population based cohort study. BMJ 2025;391:e083800.