Routine testing for prostate cancer is not recommended for most men as the benefit is small and uncertain and it also has a number of harmful effects, suggest experts.

Acknowledging that some men, such as those with a family history of prostate cancer, may be more likely to consider screening, experts suggest that they should have discussions about possible harms and benefits with their doctors.

The prostate-specific antigen (PSA) test is the only widely used test currently available to screen for prostate cancer. It is used in many countries but remains controversial because it has increased the number of healthy men diagnosed with and treated unnecessarily for harmless tumours.

To explore this further, research methodologists carried out a detailed analysis of the latest evidence using the GRADE approach (a system used to assess the quality of evidence). Based on a review (more than 700,000 men in clinical trials), which found that if screening reduces prostate cancer deaths at all, the effect is very small, the panel advises against offering routine PSA screening and says most men will decline to screen because of the small and uncertain benefits and the clear harms.

However, men at higher risk of prostate cancer death (for example, those with a family history of prostate cancer or of African descent) may be more likely to choose PSA screening after discussion of potential benefits and harms of testing with their doctor, authors concluded. The findings appeared in the Journal of The BMJ.