[From Opportunistic PSA Testing to Individualized, Risk-Adapted Early Detection of Prostate Cancer in Germany]

Early detection of prostate cancer in Germany remains predominantly opportunistic. An organized, quality-assured, invitation-based program has not yet been established. Instead, current practice is characterized by heterogeneous prostate-specific antigen (PSA) testing, variable counseling, and inconsistent downstream diagnostic pathways. However, both the evidence base and the guideline landscape have evolved substantially. The updated German S3 guideline recommends a PSA-based, risk-adapted early detection strategy from the age of 45 years following informed, non-directive counseling. This approach includes a baseline PSA measurement, interval-based reassessment, and a clearly defined diagnostic workup. The 2026 European Association of Urology guidelines follow the same overarching principle of individualized, risk-adapted early detection, but adopts a more conservative starting age of 50 years for men without additional risk factors. The key question is therefore no longer whether unselected annual PSA testing for all men is justified, but whether Germany should now consistently transition from opportunistic testing to a structured, individualized, and quality-assured early detection strategy. There are compelling arguments in favor of initiating this pathway at the age of 45 years with structured counseling and a baseline PSA measurement, not as an invitation to overtesting, but as the entry point to a strategy that can subsequently be de-intensified according to individual risk. Such an approach is clinically plausible, epidemiologically well founded, increasingly supported by contemporary German and European data, and more convincing from a health policy perspective than perpetuating the current gray zone between statutory early detection based on digital rectal examination and the de facto opportunistic use of PSA testing.