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The rate of PSA testing has soared by a third since 1999, with GPs in affluent areas bearing the brunt of the surge, the most comprehensive UK study to date reports.

The results suggest screening on demand is creating deep divides between different sectors of society, with the better off having significantly higher testing rates.

Black and Asian patients typically had low rates of testing, although Afro-Caribbean and certain African populations have a higher risk of prostate cancer than other ethnic groups.

Dr Jane Melia, lead researcher at the Institute of Cancer Research's Cancer Screening Evaluation Unit, said differences in awareness of symptoms, use of health care and response to screening were among the reasons for the disparities.

But she said no benefits had been shown for PSA testing in any group.

'There has been no trial which has shown it reduces mortality and we're very concerned about the number of cancers being overdiagnosed,' she added.

Dr Melia's team tracked testing rates in 469,159 men aged 45-84. Between November 1999 and November 2001, six-monthly testing rates increased from 2.7 per cent to 3.6 per cent.

Once researchers had adjusted for the high degree of affluence among the study population, they calculated a national annual testing rate of 5.4 per cent among men with no previous diagnosis.

Under NHS guidance, an average of 14 per cent of asymptomatic men tested would have been referred for biopsy, according to the study, which is published in July's BJU International.

Dr James Kingsland, member of the expert advisory group on prostate cancer and GP in Wallasey, Liverpool, was unsurprised by the inequalities highlighted in the data. 'The issue has been raised in the Sunday Times and on Radio 4 so more men who are better informed and in the highest social classes start to ask their GPs for tests,' he said.

But he reiterated that PSA testing does not meet the criteria for screening and said it should be used discerningly in symptomatic individuals and for monitoring treatment.

By Emma Wilkinson

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