Intended for healthcare professionals


What should doctors say to men asking for a PSA test?

BMJ 2018; 362 doi: (Published 05 September 2018) Cite this as: BMJ 2018;362:k3702
  1. Martin Roland, emeritus professor of health services research1,
  2. David Neal, professor of surgical oncology2,
  3. Richard Buckley, patient living with prostate cancer
  1. 1Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  2. 2Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
  3. Corresponding author. M Roland mr108{at}

Patients need individual discussions about the benefits and harms of testing

A BMJ Rapid Recommendation in this issue1 reviews the evidence2 behind prostate cancer screening, including the latest large trial of prostate cancer screening with the prostate-specific antigen (PSA) test which showed no difference in prostate cancer mortality after 10 years.3 Neither the US Preventive Services Task Force4 nor Public Health England5 recommend population screening as there is little evidence that screening would reduce deaths from prostate cancer. However, both countries suggest that decisions about prostate cancer testing should involve discussion with individual patients of the potential benefits and harms of testing.

Prostate cancer deaths are common and now exceed breast cancer deaths in the UK, in part because the ageing population makes prostate cancer more common and in part because of advances in the treatment of breast cancer. Men will therefore continue to come to their general practitioners asking for a test, and their experiences vary greatly from …

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