The informed choice approach leads to high rates of non-routine PSA testing, especially among those who are least advantaged and most likely to be harmed, say Andrew Vickers and colleagues.

Current policies regarding early detection of prostate cancer lead to overdiagnosis and inequity with minimal benefit

Screening for prostate cancer with prostate-specific antigen (PSA) remains highly controversial because it is not clear whether the benefits of reduced mortality from prostate cancer outweigh the harms from prostate cancer. overdiagnosis And over-medication. Given this uncertainty, most high-income countries have voted not apply the national prostate cancer screening program, but allows men to get a PSA test after discussing it with their doctor.

Countries that adopt screening policies based on shared decision-making have seen high rates of PSA testing, especially among men aged 70 years and over, who are especially likely to be overdiagnosed but do not benefit from screening. This is one reason why opportunistic screening has resulted in only a small reduction in cancer deaths. In addition, relying on shared decision-making to guide PSA testing has led to an unequal distribution, with higher rates of PSA testing among the more affluent and educated.

By 2022, the European Union recommends that organized screening programs be extended to prostate cancer. We argue that high-income countries should adopt a comprehensive risk-based approach to PSA testing, designed to reduce risk overdiagnosis And over-medication, or prevent PSA testing. through clear recommendations against screening, together with a policy of making it difficult to obtain tests without a clear urological indication.

Comment

Most high-income countries, including the UK, do not have national prostate cancer screening programmes, instead allowing asymptomatic men to take a prostate-specific antigen (PSA) test if they wish, after speaking with your doctor. But the experts who wrote BMJ argue that this policy of joint decision-making has led to high rates of PSA testing and clear medical costs, with minimal benefit and injustice.

Andrew Vickers and a group of international colleagues argue that high-income countries should adopt a comprehensive risk-based approach to PSA testing, designed to reduce risk overdiagnosis And over-medicationor preventing PSA testing through clear recommendations against screening, along with policies that make it more difficult to obtain tests no specific symptoms. Prostate cancer is the most common cancer in men and the third leading cause of cancer death in men in Europe.