PSA Testing and Prostate Checks in London 2026. What the Number Means, Why MRI Comes Before Biopsy and Who Should Be Tested
Prostate cancer is the commonest cancer in men in the UK, with around 55,000 new cases each year and a lifetime risk of roughly 1 in 8, rising to about 1 in 4 in Black men, who also develop it younger. There is no national screening programme, because PSA testing finds cancers that would never have caused harm alongside those that would, and the decision to test belongs to the man once he understands that trade-off. What has changed the calculation completely is imaging.
Key points
The PROMIS and PRECISION trials showed multiparametric MRI before biopsy detects more clinically significant cancer while letting many men avoid biopsy altogether, and NICE guideline NG131 now recommends MRI first.
A raised PSA on its own means very little in isolation. Roughly 3 in 4 men with a raised result do not have cancer on biopsy.
PSA rises with age, benign enlargement, prostatitis, a urinary infection, ejaculation within 48 hours, vigorous cycling and examination, so preparation and timing genuinely matter.
Black men and men with a family history of prostate, breast, ovarian or pancreatic cancer are commonly advised to consider testing from around 45 rather than 50.
Considering a PSA test or prostate check? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
Who should consider PSA testing
Men over 50 who want it, following an informed choice conversation. In England any man aged 50 or over can request a PSA test from an NHS GP after that discussion, and the same applies privately.
Earlier where risk is higher. Black men, whose lifetime risk is roughly 1 in 4 and who tend to develop prostate cancer younger, are commonly advised to consider starting from 45. Men with a father or brother diagnosed with prostate cancer, particularly under 60, and men with a family history of breast, ovarian or pancreatic cancer suggesting a BRCA2 mutation, which raises prostate cancer risk and aggressiveness.
Men with symptoms are in a different category and should be assessed rather than screened. Difficulty starting, a weak or interrupted stream, straining, incomplete emptying, getting up repeatedly at night, urgency, blood in the urine or semen, new erectile difficulty, or bone pain in the back, hips or pelvis. Most of those are caused by benign enlargement, which affects the majority of men as they age, but they warrant examination.
Men who have decided they would not want treatment for a cancer found early, or whose age and health mean a slow-growing cancer would never affect them, may reasonably decide not to test, and that is a legitimate choice rather than a failure to act.
What the PSA number actually means
PSA is a protein made by the prostate, and the level rises with anything that disturbs the gland rather than specifically with cancer. Benign prostatic enlargement, which is extremely common with age, raises it. So does prostatitis, a urinary infection, recent ejaculation, vigorous exercise particularly cycling, a digital rectal examination and recent instrumentation such as a catheter.
That is why preparation matters and is so often ignored. Avoid ejaculation for 48 hours, avoid vigorous exercise and cycling for 48 hours, do not test within 6 weeks of a urinary infection or prostate biopsy, and have blood taken before rather than after an examination.
Age-related thresholds are used rather than a single cut-off, with the commonly applied levels being 3.0 for men aged 50 to 69 and higher above that, though practice varies and the trend over time matters as much as any single figure. A PSA rising steadily across serial tests is more significant than one stable slightly raised result.
Roughly 3 in 4 men with a raised PSA do not have prostate cancer found on biopsy. Equally, some men with cancer have a normal PSA, which is the limitation on the other side. This is why the number is interpreted alongside examination, symptoms, risk factors and, increasingly, MRI rather than acted on alone.
Not sure whether testing is right for you? Ask on WhatsApp or email team@thewellnesslondon.com.
Why MRI before biopsy changed everything
The old pathway sent every man with a raised PSA for a transrectal biopsy, taking around 12 samples at random through the gland. It missed significant cancers because it sampled blindly, and it over-detected insignificant ones because it found small low-grade tumours that would never have caused harm, while carrying risks of infection and bleeding.
The PROMIS study compared multiparametric MRI with standard biopsy against a rigorous reference test and found MRI considerably more sensitive for clinically significant cancer. The PRECISION trial then randomised men to MRI-targeted biopsy or standard biopsy and found the MRI pathway detected more clinically significant cancer, fewer insignificant ones, and allowed a substantial proportion of men to avoid biopsy entirely because the scan was reassuring.
NICE guideline NG131 accordingly recommends multiparametric MRI as the first investigation for men with suspected clinically localised prostate cancer, scored on a 5-point Likert scale. A low score can justify avoiding biopsy with continued PSA monitoring. A higher score directs a targeted biopsy to the suspicious area, increasingly performed through the perineum rather than the rectum, which lowers infection risk.
The practical consequence for anybody weighing up whether to test is that the main historical objection, that a raised PSA leads inexorably to an unpleasant and unreliable biopsy, is no longer accurate.
What a full prostate assessment includes
The informed choice conversation first, covering what the test can and cannot tell you, the chance of a false alarm, the possibility of finding a cancer that would never have troubled you, and what each possible result would lead to. That conversation is the part most often skipped and the part that makes the test worth having.
PSA taken under the right conditions, with free to total PSA ratio where the result is borderline, since it helps distinguish benign enlargement from cancer.
Examination including digital rectal examination, and an abdominal examination for a palpable bladder.
Urine testing to exclude infection, with a flow assessment and post-void residual measurement by ultrasound where urinary symptoms are prominent, since benign enlargement is far commoner than cancer and needs treating in its own right.
Bloods covering kidney function, testosterone where symptoms suggest, HbA1c and lipids, because urinary symptoms, erectile difficulty and cardiovascular risk travel together.
Then multiparametric MRI at a specialist centre with consultant radiologist reporting where the PSA, examination or risk profile warrants it, and urology referral to a named consultant with the appointment booked where a targeted biopsy or treatment is needed.
Where we are
Portman Square, Marylebone
The Wellness is at 10 Portman Square, London W1H 6AZ, adjacent to Harley Street and 3 minutes from Baker Street.
Belgravia
Our second clinic is at the Light Centre, 9 Eccleston Street, London SW1W 9LX, close to Victoria.
What prostate assessment costs
Consultant urology appointments in the Harley Street district run £250 to £500 for a first consultation, with imaging and biopsy charged separately. Private multiparametric prostate MRI commonly runs £700 to £1,500. Transperineal template biopsy runs £2,500 to £5,000. Private prostate health packages combining PSA, examination and consultation run £400 to £900.
At The Wellness the conversation, the testing and the coordination are one pathway. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Executive Body Scan, consultant-reported organ imaging with full bloods and consolidated review, from £5,995.
Men's Body Scan programme with upper abdominal, aortic, scrotal and bladder and prostate imaging, full bloods and review, from £3,495.
Complete Biomarker Assessment, over 100 markers including PSA with free to total ratio, testosterone, kidney function, HbA1c and apolipoprotein B, with extended review, from £1,400.
Bladder and prostate ultrasound with post-void residual, assessment, consultant radiologist reporting and review, from £995.
Comprehensive Blood Panel including PSA, kidney function, testosterone and metabolic markers, with consultation and interpretation, from £495.
Extended 45-minute consultation covering urinary symptoms, PSA and erectile health together, from £395.
In-person consultation with examination, from £220. Same-day video consultation from £150. Mini consultation from £59.
Multiparametric prostate MRI, targeted biopsy and urology referral to a named consultant arranged at specialist centres with the appointment booked.
Appointments within the week at 10 Portman Square, Marylebone.
Ask what your plan would cost. Message us on WhatsApp.
Why The Wellness is the best place in London for a prostate check
Because the informed choice conversation happens before the blood is taken rather than after the result causes alarm. Understanding that roughly 3 in 4 raised results are not cancer, and that some cancers found would never have caused harm, is what makes the number useful rather than frightening.
Because the test is taken under conditions that make it meaningful. No ejaculation or cycling for 48 hours, no testing within 6 weeks of a urinary infection, and blood drawn before examination rather than after, which is the commonest avoidable cause of a falsely raised result and a fortnight of unnecessary worry.
Because a raised result leads to MRI rather than straight to biopsy, arranged at a specialist centre with consultant radiologist reporting, following the pathway NICE recommends and PROMIS and PRECISION established. That is what allows many men to avoid a biopsy altogether.
Because benign enlargement is treated as the condition it is. Most men with urinary symptoms have benign disease, and flow assessment, post-void residual measurement and proper treatment improve life considerably while the cancer question is settled separately.
And because the wider picture is assessed at the same time. Erectile difficulty is an early marker of cardiovascular disease, urinary symptoms travel with metabolic risk, and apolipoprotein B, HbA1c and blood pressure are measured alongside rather than in another appointment months later.
Related reading
Erectile dysfunction and men's health covers the cardiovascular link, biomarker screening covers the full panel, executive health screening covers the comprehensive assessment, and private ultrasound scans explains how imaging is arranged and reported.
Book a prostate assessment. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about PSA testing
Should I have a PSA test?
It is a personal decision made after an informed choice conversation. Men over 50 can request one, and earlier consideration is advised from around 45 for Black men, whose lifetime risk is roughly 1 in 4, and for men with a father or brother diagnosed with prostate cancer, particularly under 60.
What does a raised PSA mean?
Usually not cancer. Roughly 3 in 4 men with a raised PSA do not have prostate cancer found on biopsy. The level rises with age, benign enlargement, prostatitis, urinary infection, ejaculation within 48 hours, vigorous cycling and examination.
Do I need a biopsy if my PSA is high?
Not necessarily, and this has changed. NICE guideline NG131 recommends multiparametric MRI first, following the PROMIS and PRECISION studies, which showed the MRI pathway detects more clinically significant cancer while allowing many men to avoid biopsy altogether.
How should I prepare for a PSA test?
Avoid ejaculation and vigorous exercise or cycling for 48 hours, do not test within 6 weeks of a urinary infection or prostate biopsy, and have blood taken before rather than after a digital rectal examination.
Are urinary symptoms a sign of prostate cancer?
Usually not. Most urinary symptoms in older men are caused by benign prostatic enlargement, which is extremely common and treatable in its own right. They still warrant examination and a flow assessment.
This article is for information and does not replace personal medical advice. Blood in the urine, inability to pass urine or new bone pain needs urgent assessment, and in an emergency call 999. All treatments at The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM], The Wellness. Last updated September 2026.
<!-- JSON-LD SCHEMA. Paste into Squarespace page header code injection --> <script type="application/ld+json"> { "@context": "https://schema.org", "@graph": [ { "@type": "Organization", "@id": "https://www.thewellnesslondon.com/#organization", "name": "The Wellness", "url": "https://www.thewellnesslondon.com", "logo": "https://www.thewellnesslondon.com/logo.png", "email": "team@thewellnesslondon.com", "telephone": "+442039513429", "sameAs": ["https://www.theonlinegp.com", "https://www.thelondonprpclinic.com"] }, { "@type": "MedicalClinic", "@id": "https://www.thewellnesslondon.com/#portmansquare", "name": "The Wellness, Portman Square", "branchOf": {"@id": "https://www.thewellnesslondon.com/#organization"}, "medicalSpecialty": ["PrimaryCare", "Urologic"], "priceRange": "££££", "telephone": "+442039513429", "email": "team@thewellnesslondon.com", "address": {"@type": "PostalAddress", "streetAddress": "10 Portman Square", "addressLocality": "London", "postalCode": "W1H 6AZ", "addressCountry": "GB"}, "areaServed": ["London", "Marylebone", "Harley Street"], "aggregateRating": {"@type": "AggregateRating", "ratingValue": "4.9", "reviewCount": "187", "bestRating": "5"} }, { "@type": "MedicalWebPage", "name": "PSA Testing and Prostate Checks in London 2026", "description": "What a PSA result actually means, how to prepare so the number is meaningful, why NICE now recommends MRI before biopsy after PROMIS and PRECISION, and who should be tested.", "datePublished": "2026-09-01", "dateModified": "2026-09-01", "lastReviewed": "2026-09-01", "inLanguage": "en-GB", "medicalAudience": "https://schema.org/Patient", "about": [{"@type": "MedicalCondition", "name": "Prostate cancer"}], "mentions": [ {"@type": "MedicalTest", "name": "PSA test"}, {"@type": "MedicalTest", "name": "Multiparametric prostate MRI"}, {"@type": "MedicalCondition", "name": "Benign prostatic enlargement"} ], "mainEntityOfPage": {"@id": "https://www.thewellnesslondon.com/#portmansquare"}, "publisher": {"@id": "https://www.thewellnesslondon.com/#organization"}, "author": {"@type": "Organization", "name": "The Wellness medical team"}, "reviewedBy": { "@type": "Person", "name": "[GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRM]", "jobTitle": "GMC-registered doctor", "worksFor": {"@id": "https://www.thewellnesslondon.com/#organization"}, "hasCredential": {"@type": "EducationalOccupationalCredential", "credentialCategory": "GMC registration"} }, "speakable": {"@type": "SpeakableSpecification", "cssSelector": ["h1", "h2"]} }, { "@type": "FAQPage", "mainEntity": [ {"@type": "Question", "name": "Should I have a PSA test?", "acceptedAnswer": {"@type": "Answer", "text": "It is a personal decision made after an informed choice conversation. Men over 50 can request one, earlier for Black men and those with a relevant family history."}}, {"@type": "Question", "name": "What does a raised PSA mean?", "acceptedAnswer": {"@type": "Answer", "text": "Usually not cancer. Roughly 3 in 4 men with a raised PSA do not have prostate cancer found on biopsy."}}, {"@type": "Question", "name": "Do I need a biopsy if my PSA is high?", "acceptedAnswer": {"@type": "Answer", "text": "Not necessarily. NICE guideline NG131 recommends multiparametric MRI first, allowing many men to avoid biopsy altogether."}}, {"@type": "Question", "name": "How should I prepare for a PSA test?", "acceptedAnswer": {"@type": "Answer", "text": "Avoid ejaculation and vigorous exercise for 48 hours, avoid testing within 6 weeks of a urinary infection, and have blood taken before examination."}} ] }, { "@type": "BreadcrumbList", "itemListElement": [ {"@type": "ListItem", "position": 1, "name": "Home", "item": "https://www.thewellnesslondon.com"}, {"@type": "ListItem", "position": 2, "name": "Blog", "item": "https://www.thewellnesslondon.com/blog"}, {"@type": "ListItem", "position": 3, "name": "PSA Testing and Prostate Checks London"} ] } ] } </script>
