TOPLINE

Asymptomatic prostate-specific antigen (PSA) testing in primary care was associated with a lower risk for mortality due to prostate cancer than no testing.

METHODOLOGY

• Researchers conducted a nested case-control study using a primary care database containing medical records of patients from England and Wales to investigate the association between PSA testing and mortality due to prostate cancer.
• Men aged 55-84 years who died with prostate cancer as the underlying cause of death were identified (n = 2919) and matched with three control individuals (n = 8757); another control group included 2919 men diagnosed with prostate cancer who were alive.
• PSA testing was performed between 4 months and 2 years before the date of diagnosis and classified as asymptomatic testing, symptomatic testing, surveillance, related to action, or not related to any medical codes.
• PSA levels were grouped as 0-1, > 1-2, > 2-3, > 3-5, > 5-20, and > 20 ng/mL.

TAKEAWAY

• Among men who underwent a PSA test, 30% were symptomatic, and 75.7% of men who died of prostate cancer and 72.0% of control individuals from the general population did not undergo a PSA test.
• Men with asymptomatic PSA testing between 4 months and 2 years before diagnosis had lower odds of fatal prostate cancer than those with no PSA testing (adjusted odds ratio [aOR], 0.66; 95% CI, 0.55-0.79), whereas symptomatic testing was associated with increased odds (aOR, 1.30; 95% CI, 1.13-1.49).
• Among men with prostate cancer, those who underwent any PSA test (asymptomatic or symptomatic) between 4 months and 2 years before diagnosis had lower odds of death than those who did not undergo PSA tests (OR, 0.27; 95% CI, 0.22-0.33 for asymptomatic testing and OR, 0.54; 95% CI, 0.42-0.69 for symptomatic testing).
• The risk for death due to prostate cancer increased with rising PSA levels: Men who had PSA levels of 0-1 ng/mL had a lower risk for mortality due to prostate cancer than those who were not tested (aOR, 0.13; 95% CI, 0.09-0.19), whereas those with PSA levels > 20 ng/mL had an increased risk for mortality due to prostate cancer (aOR, 19.30; 95% CI, 12.40-30.94).

IN PRACTICE

"While our study reports lower prostate cancer mortality among men with prior PSA testing, patient outcomes are broader than mortality alone. Opportunistic PSA testing can lead to low-risk prostate cancers that may have never become clinically significant, resulting in overdiagnosis and over treatment," the authors of the study wrote.

SOURCE

The study was led by Shama Riaz Sheikh, MSc, Centre for Cancer Screening, Prevention and Early Diagnosis, Queen Mary University of London, London, England. It was published online on June 19, 2026, in BJGP Open.

LIMITATIONS

The reason for PSA testing may be inaccurately classified because it relied on information from general practice records in which patients might not have accurately reported their symptoms and levels of details may have varied. Staging and grading were not consistently recorded and were not included in the analysis.

DISCLOSURES

Three authors received support from Cancer Research UK. The Queen Mary University of London served as the sponsoring organisation for the data and material in the study. One author disclosed receiving a Yorkshire Cancer Research grant for a trial of prostate cancer screening and serving on the scientific advisory board of GRAIL. Another author disclosed serving as an associate editor for BJGP.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.