There is a ‘large variation’ between GP surgeries when it comes to the use of a prostate cancer test for men who have no signs of the disease, according to a study.
The prostate-specific antigen (PSA) test is a blood test which is used to check for prostate conditions including prostate cancer or an enlarged prostate.
Routine PSA testing is not currently offered on the NHS, but patients may be offered a PSA test if a GP suspects they have prostate cancer.
And men over the age of 50 can ask their GP for a PSA test, even if they do not have symptoms.
New research has found there is a significant variation between GP surgeries in the proportion of men with no symptoms (asymptomatic) who are given the test.
Experts from the Universities of Exeter, Manchester and Newcastle and University College London, set out to examine the proportion of prostate cancer patients who were given a test even though they had no symptoms.
The research team analysed more than 9,800 records of men with prostate cancer from the 2018 English National Cancer Diagnosis Audit.
These men were registered at 1,639 general practices across England.
Routine prostate-specific antigen (PSA) testing is not currently offered on the NHS but men over the age of 50 can ask their GP for a test, even if they do not have symptoms (file image)
More than 12,000 men die from prostate cancer every year and one in eight men will be diagnosed with prostate cancer in their lifetime (file image)
They found that 19.2 per cent of prostate cancer cases studied were detected through asymptomatic PSA testing.
‘There was a 13-fold variation between practices in the odds of detecting prostate cancer through asymptomatic PSA testing, without clear explanatory practice-level factors,’ they wrote in the British Journal of General Practice.
Researchers said that the variation ‘speaks to the ongoing lack of clarity regarding prostate cancer screening practice in the UK’.
Professor Gary Abel, from the University of Exeter, who led the study, said: ‘It is hard to know what to do when the evidence isn’t clear but a more consistent approach to testing people without symptoms is needed to help redress this imbalance.’
Lead author Dr Sam Merriel, from the University of Manchester and a practising GP, said: ‘Inconsistencies in local, regional and national guidance mean it is really down to individual GPs to make decisions on which patients to test, how often to test, and what PSA thresholds warrant urgent referral for suspected cancer.
‘These inconsistencies may be contributing to the variation in whether GPs are detecting prostate cancer in patients who do not have symptoms.’
The authors also found that patient factors ‘were found to have a profound impact on PSA testing’.
Younger men, those with fewer illnesses and people from less deprived areas were more likely to have their prostate cancer detected after asymptomatic PSA testing.
Prostate cancer can develop when cells in the prostate start to grow in an uncontrolled way (file image)
And men from non-white backgrounds were more likely to be diagnosed after asymptomatic PSA testing compared with white men.
Naser Turabi, director of evidence and implementation at Cancer Research UK, which funded the study, said: ‘This study highlights variation in the detection of prostate cancer through PSA testing in men with no symptoms.
‘The possibility of a cancer diagnosis can be extremely worrying, so we understand why some men ask for the PSA test. However, the evidence shows that it can cause more harm than good for men who have no prostate cancer symptoms.
‘The UK National Screening Committee is constantly reviewing the best evidence and doesn’t currently recommend screening for prostate cancer.
‘We’re determined to find better ways to detect and treat prostate cancer and we will continue to fund research to improve our understanding and help save lives.’
Prostate Cancer UK has called for guidelines to be changed so GPs can have ‘proactive’ discussions about getting tested with men at highest risk of disease.
Amy Rylance, assistant director of health improvement at Prostate Cancer UK, said: ‘We’re calling on the Government to change outdated NHS guidelines so that GPs can start having proactive conversations with men at the highest risk of getting prostate cancer about their risk and the option to get tested.
‘This simple move would reduce the confusion for both men and GPs and save thousands of lives every year.’
Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: ‘GPs want to ensure that we are having the right conversations with our patients when it comes to the risk of prostate cancer, especially when it comes to high-risk groups.
‘Research so far suggests that the prostate specific antigen (PSA) test is not reliable enough to detect prostate cancer that needs treatment, which is why current guidelines do not suggest pro-actively offering it to patients without symptoms.
‘But it is important that both patients and healthcare professionals have accessible information about prostate cancer – including risk factors and symptoms, and the risks and benefits of testing – to avoid regional variation and to ensure that health inequalities aren’t exacerbated.’
Around 55,000 men are diagnosed with prostate cancer and around 12,000 men die from the disease each year in the UK.
