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Prostate screening (PSA)
Latvia and Lithuania fund PSA testing for men in their fifties and sixties. Sweden assessed the same evidence and recommends against an organised programme. Here is what the trials actually found.
This page describes screening programmes; it is not a diagnosis, not a personal risk assessment and not a substitute for your own health service. Age bands are set nationally and change — the invitation you receive, and the body named on your country page, outrank anything written here. Screening is for people without symptoms: a new lump, blood you can see, a mole that has changed, unexplained weight loss or a sudden change in vision or hearing needs a clinician now, whatever a recent screening result said.
Where it is organised, and at what age
Every country in this region that runs this as an organised programme, with its own age band. Bands differ because national bodies weigh the same evidence differently, not because one of them has it wrong.
| Country | Who | Age band and interval | Test | How it reaches you |
|---|---|---|---|---|
| Latvia | Men | 50–75, every 2 years | PSA blood test | Ask your family doctor |
| Lithuania | Men | 50–69, every 2 years | PSA blood test; from 45 with a family history | Ask your family doctor |
What PSA measures, and what it does not
Prostate-specific antigen is a protein made by the prostate, and its level in blood rises with prostate cancer. It also rises with benign enlargement, with prostatitis, after a urinary infection, after a long bicycle ride and after ejaculation. It is a prostate test, not a cancer test. That is the root of every difficulty in this section: a raised PSA sends men down a diagnostic pathway most of whom did not need, while a normal PSA does not guarantee the absence of cancer.
The trial evidence, without the spin
The European randomised study of screening for prostate cancer is the largest trial, and at thirteen years of follow-up it found one prostate cancer death averted for every 781 men invited to screening, and for every 27 extra cancers detected. The Cochrane review of the randomised trials concluded that screening did not significantly reduce prostate-cancer-specific mortality overall. Both statements are true; they weigh the same data differently. What is not in dispute is the denominator: many men are diagnosed and treated so that a few avoid dying.
Why overdiagnosis matters more here than anywhere else
Prostate cancer is common, often slow, and frequently never becomes a problem in a man’s lifetime. Screening finds those indolent cancers efficiently, and until recently a diagnosis usually meant surgery or radiotherapy, with rates of incontinence and erectile dysfunction that are not trivial. This is the strongest example in medicine of a screening test whose harms are concrete and whose benefits are statistical. It is why Sweden’s national body assessed PSA screening for men aged 50 to 70 and recommended against offering it.
What has changed: MRI first, and active surveillance
The picture is genuinely improving. Doing an MRI before deciding on a biopsy lets many men with a raised PSA avoid biopsy altogether and helps find the cancers that matter. And active surveillance — monitoring a low-risk cancer with repeat tests rather than treating it — is now standard practice, which decouples "diagnosed" from "treated" for a large share of screen-detected disease. Research programmes across Europe are testing whether a risk-stratified pathway built this way can shift the balance enough to justify organised screening, and the 2022 European recommendation asks countries to pilot exactly that rather than to roll it out.
If you are deciding
This is a decision to make with a doctor, not from a table. What should feed into it: your age, your family history — a father or brother with prostate cancer raises risk substantially, and several countries lower the funded starting age to 45 on that basis — your ethnic background, other health conditions that shape how much a slow cancer would matter, and how you personally feel about the trade between knowing and not knowing. Urinary symptoms, incidentally, are usually benign enlargement rather than cancer, but they are a reason to see a doctor rather than a reason to order a test online.
Sources: ERSPC, prostate cancer mortality at 13 years of follow-up, The Lancet 2014 · Cochrane Database of Systematic Reviews — Screening for prostate cancer (Ilic and colleagues) · Socialstyrelsen — prostate cancer screening: recommendation not to offer · SPKC — prostate cancer preventive check, men 50–75 every two years · checked 2026-09-07
Perguntas frequentes
Should I have a PSA test?
There is no single right answer, which is why neighbouring countries disagree. It is a decision to discuss with a doctor, weighing your age and family history against the fact that many men are diagnosed and treated for every one who avoids dying of prostate cancer.
Why does Sweden recommend against PSA screening when Lithuania funds it?
Both read the same trials. Sweden weighs the overdiagnosis and treatment harms as outweighing a small mortality benefit; Lithuania and Latvia weigh them the other way and fund the test through the family doctor. The evidence is genuinely finely balanced.
What does a raised PSA mean?
Most often something other than cancer: benign enlargement, inflammation, a recent infection, cycling or ejaculation all raise it. It means a conversation and usually an MRI before any decision about biopsy, not a diagnosis.
Does a normal PSA mean I do not have prostate cancer?
No. PSA is a prostate test rather than a cancer test, and some cancers occur at normal levels. Symptoms should be assessed on their own merits whatever the number was.
The rest of the surface
Breast cancer screening (mammography)
An X-ray of each breast, read by two radiologists, repeated every two years across a band of ages that starts at 40 in Sweden and 50 almost everywhere else. What it finds, what it misses and what a call-back means.
Cervical screening (HPV test)
Almost every country in the region has switched from looking for abnormal cells to looking for the virus that causes them. The test is better, so the gap between tests is longer — and in several countries you can now take the sample yourself.
Bowel cancer screening (stool test)
A sample from one bowel movement, taken at home and posted. It is the only screening programme in the region that routinely prevents cancers rather than only finding them early — because the follow-up removes the polyp.
Lung cancer screening (low-dose CT)
The trials are positive and the European recommendation asks countries to build programmes stepwise. In this region it is still pilots rather than invitations — but the eligibility rule is worth knowing.
Abdominal aortic aneurysm scan
The only non-cancer screening programme in the region. Sweden offers men a single abdominal ultrasound in the year they turn 65, looking for a silent widening of the main artery.
What screening can and cannot do
Overdiagnosis, false positives, interval cases and lead-time bias — the four ideas behind every disagreement between countries.
All 27 screening pagesIf the result is not normal
The record that makes the appointment shorter
TempoLife keeps weight, blood pressure, sleep and symptoms in one place, so the questions you get asked at a screening appointment already have answers.