Suffering stars add to worries about prostate cancer ‘overtesting’

Celebrity prostate cancer awareness campaigns have contributed to harmful “overtesting” in men without symptoms, an Oxford study has found.

Researchers examined the health records of ten million men in England, looking at trends in the number of people receiving PSA tests — a blood test that can indicate prostate cancer.

Men over the age of 50 can ask their GP for a PSA test, but the tests are seen as too unreliable to be offered routinely on the NHS because they can lead to unnecessary and harmful treatments with side-effects such as incontinence and erectile dysfunction.

The new study, published in the BMJ, found that requests for prostate cancer tests from men without symptoms surged during “periods of high-profile media attention”.

Tests increased by 26 per cent in 2018 after the comedian Stephen Fry and the BBC presenter Bill Turnbull said they had been diagnosed with the disease and urged men to get PSA tests. In recent months, men have been urged to get PSA tests by famous names including Gary Lineker and the Olympic cyclist Sir Chris Hoy, who has incurable prostate cancer.

The study said that the NHS should prepare for “unpredictable surges in PSA testing, overtesting and associated costs” when celebrities publicly advocated for screening. It found that men were more likely to request tests if they were wealthy, white and from the south of the country, and “that many were tested more frequently than recommended, raising concerns about overtesting”.

However, millions of other men have not been tested at all, and the authors of the University of Oxford study said that better guidelines were needed for when and how often men should get PSA tests.

Prostate cancer is the most common cancer in the UK, with 55,300 new cases and 12,200 deaths each year. The National Screening Committee, the expert body that advises the NHS, is due to make recommendations next month as to whether to introduce a screening programme. It is expected to say that the harms of mass PSA testing outweigh the benefits.

PSA — prostate-specific antigen — is a protein whose levels can be raised in prostate cancer patients. However, the tests that measure PSA are unreliable and often miss aggressive cancers, but also lead to false positives that can lead unnecessary treatment.

In the new study, about 1.5 million patients had at least one PSA test between 2000 and 2018, resulting in 3.8 million PSA tests overall. Rates of testing increased fivefold over the study period, and many men had repeat testing more frequently than recommended.

In an editorial linked to the study, Dr Juan Franco wrote that the main concern was “that unregulated PSA testing will result in large costs and harms and increase the incidence of prostate cancer likely to remain undetected, while doing little to identify prostate cancer most likely to cause symptoms and death”.

Under NHS guidelines, all men aged over 50 can ask their GP for a PSA test even if they do not have symptoms and black men, who are at higher risk, can ask for one from the age of 45. Prostate cancer charities are calling for these guidelines to be overhauled so the tests are proactively offered to men at highest risk, as part of a targeted screening programme.

Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: “This BMJ study provides yet more evidence that major inequalities in PSA testing and confusing guidance make it difficult for men and their GPs to know how to test for prostate cancer.

“Despite this, many men are still having tests — but they’re having them unequally. Some are tested more often than necessary, while others aren’t tested until it’s too late.

“The key finding of this study is that men in the affluent south are being tested more often. But this needs to be looked at in the context of other research that shows men in affluent areas are also more likely to be diagnosed early, before their cancer has spread.

“That’s why we’ve been calling for the government to urgently update current guidelines, which are dangerously outdated and continue to cause confusion for men and their clinicians.”

Naser Turabi, Cancer Research UK’s director of evidence, said: “Prostate cancer is the second leading cause of cancer death in men in the UK, taking around 12,200 lives a year. While we’ve 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 isn’t reliable enough.”