Tests for prostate cancer should not be offered on request unless men have symptoms, experts say. There is no national screening programme in the UK for prostate cancer, however asymptomatic men aged over 50 can get a test after consulting with their doctor.
A group of international experts say this policy has resulted in unnecessarily high rates of prostate-specific antigen (PSA) testing, which can lead to overdiagnosis and harm patients.
About 47,000 men are diagnosed with prostate cancer in the UK every year, but estimates suggest overdiagnosis occurs in some 10,000 men annually. Most men with an abnormal PSA result go on to have a prostate biopsy, because it is not possible to diagnose the cancer through the test alone.
However, only a minority will have aggressive prostate cancer that requires treatment. Even if low-risk tumours are detected, most men go on to have either surgery or radiotherapy which can increase the risk of urinary, erectile and bowel dysfunction.
Researchers from the University of Sheffield, Cork University Hospital, in Ireland, and the Memorial Sloan Kettering cancer centre, New York, in the US, said prostate testing should be restricted to men with urological symptoms, or targeted with a risk based early detection programme.
The analysis, published in the British Medical Journal, said relying on shared decision-making to inform testing, the standard practice in most high-income countries, has led to high testing rates among older men who are most likely to be harmed by screening, and the least likely to benefit.
"Although we believe that early detection of prostate cancer should involve shared decision making, the current approach of determining testing by shared decision making has resulted in the worst possible practical outcome of high levels of PSA testing and medical harm, with minimal benefit and inequity," the authors say.
"To make better use of PSA testing, policy makers should choose between a comprehensive, risk-adapted approach that is designed to reduce overdiagnosis and overtreatment, or restricting PSA testing to people referred to urologists with symptoms," they add.
Lead author, Dr Andrew Vickers, of Memorial Sloan Kettering cancer centre, New York, said that they hope policymakers will read the British Medical Journal paper and would respond to any enquiries they may have.
Last year, NHS England launched new "case finding" pilots to speed up the detection of missed prostate cancer cases during the pandemic.
The pilots, including in Surrey and Sussex, target men over 50, those with a close relative who has had prostate cancer and black men aged over 45.
It comes after Dame Cally Palmer, NHS England's national cancer director, told MPs in March that a push to diagnose prostate cancer cases, as well as two other cancers, through awareness drives has led to "an uptick in people seeking assessment of 7-15 per cent".
Screening for prostate cancer is not recommended in the UK, but NHS England has an "informed choice programme" where men aged 50 or older can decide to have their PSA tested after discussing with their GP.
Prostate cancer incidence has increased by about 50 per cent in the UK since PSA testing became available in the 1990s.
"Around 25-50 per cent of men who have prostate cancer detected after PSA testing would have lived out their natural lives without a prostate cancer diagnosis, suggesting that overdiagnosis occurs in about 10,000 men in the UK every year," the authors say.
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