Frequent PSA Retesting and Regional Variation Highlighted in Large England Primary Care Study

A new population‑based cohort analysis published in The BMJ investigates prostate specific antigen (PSA) testing patterns in English primary care over nearly two decades, revealing both overtesting and marked geographic and demographic disparities. 

The research drew on data from 10,235,805 men registered across 1,442 general practices in the Clinical Practice Research Datalink, linked with cancer registry, hospital, and mortality records, spanning 2000 to 2018. Among those men, 1,521,116 had at least one PSA test; of those, 735,750 (48.4 %) underwent repeat tests, resulting in 3,835,440 total PSA measurements in the cohort. The median interval between repeat tests was 12.6 months (IQR 6.2 to 27.5).

Notably, 72.8 % of men who had multiple tests never recorded a PSA value above the age‑specific referral threshold. Many were retested more frequently than current guidelines would suggest or without documented indication or symptoms. The authors found that shorter retesting intervals were associated with older age, non‑White ethnicity, a family history of prostate cancer, or previously raised PSA values.

PSA testing rates varied widely across regions, levels of deprivation, and practice settings, although retesting interval lengths were more consistent across these groups. The authors caution that such variability and frequent retesting among low‑risk or asymptomatic men suggest a risk of overtesting in primary care.

The study’s limitations include reliance on clinician recording and coding in routinely collected data, which can underrepresent patient symptoms or rationale for testing. The authors argue that to balance early detection with harms of overdiagnosis and overtreatment, more research is needed to establish evidence‑based retesting intervals. If future guidelines could better stratify risk, clinicians may better focus PSA monitoring toward men most likely to benefit.

In sum, this large‑scale English primary care study underscores how frequent PSA retesting—often in men without symptoms or elevated values—and regional variation persist despite efforts to rationalize testing. Fine‑tuning retesting intervals, improving communication around PSA screening, and aligning practice with evidence could enhance value in prostate cancer monitoring.