Prostate cancer screening looks different in Europe in 2025. The focus is moving from one-size-fits-all checks to a risk-adapted screening approach. In practice, it means starting the conversation with a PSA test, looking at trends rather than a single figure, and using MRI before biopsy when it genuinely adds value. PSA is a protein measured in blood; levels can rise for benign reasons such as infections, cycling or prostate enlargement.
Men in their forties often ask the same three questions: when to start, how often to repeat, and what to do if a result nudges upward. This guide turns that into a clear plan for Europe: who counts as high risk, how your baseline PSA shapes the screening interval, when an mpMRI can spare you from unnecessary procedures, and the exact questions to take to your appointment.
If you prefer to discuss options online, you can speak with a GP or urologist via Oladoctor. We keep the advice practical, safety-first, and free of scare stories, so you can make decisions that fit your health and your life.
This content is general and for information only. It is not medical advice and does not replace a consultation with a qualified clinician. Do not rely on it to diagnose or treat any condition. If you have symptoms or concerns, speak to a doctor. In an emergency, call your local emergency number. Oladoctor is not a healthcare provider and does not practice medicine. Screening decisions should be made with a clinician who knows your history and the local guidelines.
What changed between 2022 and 2025?
Europe moved from ad-hoc checks to structured, risk-adapted screening. In December 2022 the EU Council recommendation encouraged Member States to evaluate organised programmes that start with a PSA test and use MRI before biopsy when results look suspicious. By 2025 this direction shapes national pathways and pilots across the region, with ongoing monitoring to balance benefits and harms.
The EAU guidelines emphasise individual risk, baseline PSA, and shared decision-making. They support MRI as a gatekeeper to reduce unnecessary biopsies and to target clinically significant disease rather than every abnormal reading. In plain terms, the default is no longer biopsy first.
Several countries refined their clinical steps in line with this. In the UK, NICE guidance (reviewed in August 2025) keeps MRI up front in the diagnostic pathway and highlights the role of repeat PSA when suspicion is low. Studies such as PROBASE support longer screening-interval options for men with a very low baseline PSA, which helps to cut overtesting.
Who should consider testing from 40+? (risk groups)
Most men can discuss a first PSA test in their mid-40s to early 50s, then follow a risk-adapted plan based on their baseline PSA and overall health. European guidance now frames early detection around individual risk and expected benefit, rather than automatic, universal checks.
You are considered high-risk if you have a strong family history of prostate or related cancers, known cancer-predisposition genes such as BRCA2, or Black ancestry. For these groups, experts recommend beginning discussion and testing from about 40–45, with some guidance supporting annual PSA for BRCA2 carriers. If that is you, plan a personalised schedule with a clinician rather than waiting for symptoms.
Family history and ancestry matter because risk is higher and cancers can present earlier.
Two practical rules help wherever you live in Europe. First, weigh screening against life expectancy and co-morbidities, since the aim is to catch clinically significant disease you would live long enough to benefit from treating. Second, let the baseline PSA guide your screening interval: very low results often allow longer gaps, while higher baselines call for closer follow-up and, if indicated, MRI before biopsy. Your doctor on Oladoctor can translate this into a simple schedule you can stick to.
The PSA test: what the number means and how often to repeat
The PSA test starts the conversation, not the diagnosis. The number is influenced by age, prostate size, infections and some medicines. European guidance favours a risk-adapted approach in which a baseline PSA helps set your next check rather than a fixed annual test EAU 2024 and risk-adjusted screening review.
How often to repeat depends on that first result and your risk. With a very low baseline PSA, clinicians may use multi-year gaps; for example, a large European study retests men with PSA under 1.5 ng/mL after five years PROBASE summary. For those deemed at risk, pathways often use around two-year intervals, while very low-risk men may stretch to longer intervals such as up to eight years EAU intervals (summary).
If PSA is raised but suspicion is low, repeating the test rather than rushing to biopsy is common. UK guidance reviewed in 2025 advises a repeat PSA at 3–6 months when MRI is low-suspicion, with decisions guided by overall risk NICE NG131 recommendations. Doctors also consider trend and density; a commonly used PSA-density threshold is about 0.15 (that means PSA divided by prostate volume on ultrasound or MRI).
Prepare properly before a test to avoid false alarms. Avoid ejaculation and vigorous cycling for 48 hours, and do not test while you have a urinary infection; recent procedures like biopsy or cystoscopy can also raise PSA temporarily GOV.UK guidance.
What to do next: Low baseline PSA — agree a long interval. Borderline result — repeat in 3–6 months. Persistent or rising PSA — discuss MRI and risk tools with your clinician.
Why MRI before biopsy matters (and how pathways look)
MRI before biopsy matters because it rules in the right cancers and spares many men an unnecessary procedure. Modern European pathways recommend a pre-biopsy multiparametric MRI to triage risk and target lesions that actually look suspicious EAU guideline hub and EAU 2024 pocket. Trials such as PRECISION and STHLM3-MRI showed higher detection of clinically significant disease and less over-diagnosis when MRI guides biopsy, while PROMIS highlighted the strong negative-predictive value of a good-quality scan.
How pathways look in practice is simple and safety-first. MRI results are reported with PI-RADS (a 1–5 scale for how suspicious the MRI looks); decisions then combine image score with PSA trend and density. If suspicion stays low, repeat PSA is preferred over rushing to biopsy. Community cohorts in 2025 also support the feasibility and oncological safety of MRI-informed pathways in routine care JAMA Oncology 2025.
- Step 1: Raised PSA or high-risk profile → order pre-biopsy mpMRI NICE pathway (PDF).
- Step 2: PI-RADS 1–2 (low suspicion) → repeat PSA at 3–6 months; continue follow-up if risk remains low.
- Step 3: PI-RADS 3 (equivocal) → use PSA density to refine the call; a threshold around 0.15 can signal higher risk and the need for biopsy PSA density review.
- Step 4: PI-RADS 4–5 (high suspicion) → proceed to targeted biopsy (cognitive or fusion), with additional cores per local protocol.
What to do next: After MRI, combine PI-RADS with PSA trend and density to choose between watchful waiting, repeat testing, or targeted biopsy.
New tools in 2025: genetic saliva (PRS) and other adjuncts
Genetic saliva tests using a polygenic risk score (PRS) moved into the spotlight in 2025. The BARCODE1 results suggest PRS can enrich for clinically significant cancers and find men who might be missed by conventional pathways NEJM 2025. A lay summary from the Institute of Cancer Research explains the “spit test” concept and why it could complement, not replace, existing checks ICR news.
What does this mean right now? PRS is promising but not a stand-alone screening tool; regulators and guideline groups are still reviewing how to deploy it and for whom ESMO update. Other adjuncts can refine decisions after an initial PSA. The Stockholm3 (STHLM3) model combines clinical variables, kallikrein markers and genetic information to outperform PSA alone in selected settings European Urology Oncology 2023.
Risk calculators help tailor who needs imaging or biopsy. A widely used option is the ERSPC tool ERSPC risk calculator. Commercial biomarker panels such as PHI or 4Kscore may reduce avoidable biopsies in equivocal cases; evidence continues to evolve across European cohorts diagnostic meta-analysis (2024).
Home testing vs clinical testing: safety first
Home PSA kits look convenient, but a finger-prick result without clinical context can mislead. A balanced overview from Prostate Cancer UK explains what self-testing can and cannot tell you PSA self-test kits.
Clinical testing is safer because samples go to accredited labs and results are interpreted alongside symptoms, exam and history. Preparation reduces false alarms: avoid ejaculation and hard cycling for 48 hours, do not test during a urinary infection, and tell your clinician about recent procedures that can raise PSA. Practical how-to information is available from Prostate Cancer UK PSA blood test.
- Choose the setting: Venous blood test with clinical interpretation rather than a stand-alone kit NHS PSA test.
- Time it right: Infections and procedures can elevate PSA; your team may suggest waiting before retesting BAUS leaflet.
- Plan follow-up: Borderline or rising results are often repeated and then triaged with MRI if risk stays high Cancer Research UK.
If you want a clear plan, book a GP or urologist through Oladoctor. They can arrange lab testing and interpret the result in context, so you avoid over-testing and under-treating.
Informational only — not medical advice. If you have symptoms or an abnormal result, speak to a clinician; in an emergency call your local emergency number.
What to ask your doctor (printable checklist)
Use this quick checklist to keep your appointment focused and practical. It helps you and your doctor align on prostate cancer screening goals—from a baseline PSA and screening interval to whether an mpMRI is warranted.
- Based on my age, family history and ancestry, am I high-risk—and should we start screening now?
- Is a baseline PSA appropriate for me at this visit, and how will you interpret it given my risk profile?
- What screening interval do you recommend if my PSA is low, and how would that change if it is higher or rising?
- Which temporary factors could raise my PSA (infection, ejaculation, cycling, recent procedures), and when should we repeat if today’s result is elevated?
- At what point would you order an mpMRI, and how do PSA density or risk calculators influence that decision?
- If MRI shows low suspicion (PI-RADS 1–2), what is the follow-up plan—timing of repeat PSA and imaging?
- When would a biopsy be indicated, and how do we minimise overdiagnosis and overtreatment?
- Should I consider genetic counselling or testing (e.g., BRCA), or could I be eligible for a polygenic risk score (PRS) study?
- Do any of my medicines (e.g., finasteride, tamsulosin) affect PSA or your thresholds for imaging and biopsy?
- If I’m travelling or living abroad, can we coordinate labs and imaging through Oladoctor, and how will we share and track results?
Save these questions on your phone or print them before the visit. If you prefer to organise labs or imaging remotely, book a GP or urologist via Oladoctor and agree a personalised plan with clear review points and a realistic screening interval.
When to stop testing (and why)
Stopping makes sense when the potential harms outweigh the benefits. European proposals for organised programmes suggest discontinuing routine testing above 70, with individual exceptions based on risk and health status EU early detection synthesis (2024). Outside Europe, some bodies recommend stopping at 70 altogether, reflecting a conservative balance of benefits and harms USPSTF. For men aged 80+, UK primary-care advice urges careful case-by-case decisions, especially if testing was not previously part of shared decision-making AOMRC EBI.
Two practical signals can simplify the decision. First, a very low PSA at around 60 may justify phasing out or greatly lengthening the screening interval in low-risk men BJUI 2024. Second, if you remain in good health with a higher or rising PSA and no prior biopsy, some experts support continued surveillance when life expectancy clearly exceeds 10 years—always as a shared decision European Urology 2023.
What to do next: If you are near 70 or have complex health issues, ask your GP whether continued testing is likely to benefit you; agree a plan that avoids overdiagnosis and unnecessary procedures.
