EAU 2024: Risk Adapted Screening for Prostate Cancer in Europe: PSA + MRI (OPT - the Swedish Nationwide Screening Strategy)

(UroToday.com) The 2024 European Association of Urology (EAU) annual meeting featured a plenary session highlighting risk adapted screening for prostate cancer in Europe and a presentation by Dr. Jonas Hugosson discussing the Swedish national OPT approach of PSA + MRI screening. OPT is a Swedish nationwide screening strategy introduced in 2020 whereby the three most populated Swedish regions invited all men aged 50 years to OPT by a letter in 2020-2022. Men with a PSA ≥3 ng/ml were referred for prostate MRI. Men with a PI-RADS 1-3 lesion and PSA density ≥0.15 ng/ml/cm3 or PI-RADS 4-5 were referred for a biopsy.

The results from the first invitation of men to OPT were recently published in European Urology.1 Dr. Hugosson notes that there were 23,855 (35%) of 68,060 invited men participated. There was considerable variation in PSA between regions, as well as the distribution of Gleason Grade, despite identical age and very similar diagnostic pathways across the three regions. As follows are the diagnostic outcomes of the three programs as percentages of men having a PSA test:


This initial round of screening concluded that inter-regional differences in diagnostic outcomes show a need for standardization of the diagnostic pathway’s components. Dr. Hugosson notes there are several reasons for using a PSA before an MRI:

  1. To reduce the number of MRI scans (save resources)
  2. To avoid MRI driven over-diagnosis

In Sweden, the implementation of pre-biopsy MRI has decreased the detection of low grade prostate cancers, but increased detection of intermediate risk prostate cancer. This could be an artifact due to more accurate grading with targeted biopsies compared to systematic biopsies:


Dr. Hugosson concluded his presentation by discussing the Swedish national OPT approach of PSA + MRI screening with the following conclusions:

  • The OPT program is feasible, with good compliance with the diagnostic pathway
  • The use of MRI and PSA density reduced the biopsy rate to half in men with PSA >= 3 ng/mL
  • The use of PSA or alternative blood-based biomarkers as an initial screening test saves MRI resources and reduces over-diagnosis of Grade Group 1 and 2 cancers
  • The optimal PSA cut-off for MRI is currently unknown

Presented by: Professor Jonas Hugosson, MD, University of Gothenburg, Gothenburg, Sweden

Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 European Association of Urology (EAU) annual congress, Paris, France, April 5th - April 8th, 2024


  1. Bratt O, Godtman RA, Jiborn T, et al. Population-based Organized Prostate Cancer Testing: Results form the First Invitation of 50-year-old Men. Eur Urol. 2024 Mar;85(3):207-214.