PSA testing has not increased in general practice in the UK despite raised public awareness and highly publicised research findings. Older men and men living in more affluent areas were most likely to be tested, a practice-based study has found.

Retrospective data were analysed for the year 2007, for all men aged 45-89 years in 87 GP surgeries taking part in a larger prostate cancer study. These practices were distributed across the country in Bristol, Cambridge, Leicester, Sheffield, Leeds and Newcastle. Information was obtained on 126,716 men with no previous diagnosis of prostate cancer.

Overall, 7,902 men, 6.2% (95% CI: 5.6-7.0%) underwent a PSA test during the 12 months analysed. PSA testing rates were 1.4% (95% CI: 1.1-1.6%) in men aged 45-49, compared with 11.3% (95% CI: 10.0-12.9%) in those aged 75-79.

Testing rates were significantly lower in the three northern centres compared with the three more southern ones. Rates of testing were also found to be closely linked to scores of social deprivation, with highest testing rates in more affluent areas. Lower proportions of men were subsequently diagnosed with prostate cancer in those practices testing more men.

A strong positive correlation was seen between testing rates and increasing age (perhaps influenced by testing of PSA in men presenting with LUTS); 44% of tests were performed in men >70 and 13% in men >80 years old.

The study concludes, that the UK has not seen a continued increase in rates of PSA testing, as previously seen in the late 1990s, and that testing rates are significantly lower than those in many other European countries and the US.

Uptake of testing remains low in the UK with significant skew towards older, more affluent men. Clearly, current national policy of an informed choice for all men is not working and this study reinforces the need for more robust guidance.

Dr Jonathan Rees

• Williams N, Hughes LJ, Turner EL et al. Prostate-specific antigen testing rates remain low in UK general practice: a cross-sectional study in six English cities. BJU Int 2011; doi:10.1111/j.1464-410X.2011.10163.x