Prostate specific antigen (PSA) testing in the UK population and its implications
What is the aim of the study and why is it important?
Screening tests can be used to find cancers at an early stage before symptoms appear. For prostate cancer, a blood test called PSA can be used. A good screening test should find prostate cancers earlier, before they have spread to other parts of the body. By finding and treating cancers earlier, fewer men should die from prostate cancer. Several studies have tried to see if prostate screening can prevent prostate cancer deaths, but the results are not clear. There are also concerns about screening causing unnecessary anxiety or further tests. In the UK, men can have this PSA test if they ask their GP but there is not a national screening programme.
Our project seeks to answer several questions about prostate screening in the UK:
How many men are having PSA tests for cancer screening?
Do different areas in the UK have different levels of screening?
Are men that have a higher risk of prostate cancer having more PSA screening?
What are the benefits and risks of choosing to have prostate screening?
How is the research being done?
We will use a large patient database called QResearch to find information on men who had PSA testing done for prostate screening, but had no symptoms of prostate problems. We will see if screening is more or less likely depending on whether men are from wealthy or poor areas, where they live in the UK, what ethnicity they are, and if they are at high risk of prostate cancer. An important part will be looking at what happens to men if they choose prostate screening compared with men who don’t – are they treated differently, does it affect their survival, and what are the consequences?
Location of research
Date on which research approved
Project reference ID
Generic ethics approval reference
Are all data accessed are in anonymised form?
Brief summary of the dataset to be released (including any sensitive data)
Cohort of men aged 40-75 years registered with the GP practices between 1998 and 2017.
GP data included age, deprivation score, ethnicity, body mass index, smoking status, family history prostate cancer, mental health diagnoses, diabetes, prostate specific antigen tests, urinary tract symptoms.
Mortality data included cause of death and date of death
Hospital Episode Statistics Diagnoses of prostate cancer
Cancer Registry Diagnoses of prostate cancer and associated dates
Implications and Impact
There is a lot of debate about the benefits and harms of prostate screening. Other studies are not clear about this. Our study offers a new way of seeing if prostate screening is safe in the UK, as we can find large numbers of men who have had screening, and see what happened to them. If prostate screening is safe, we can measure its benefits, and find ways to improve it. If the risks and benefits are balanced, then the NHS and government can use this to develop better ways of screening for prostate cancer in the future.
Not externally funded
Ashley K Clift, Carol Coupland, Julia Hippisley-Cox: University of Nottingham