MXenes are gaining immense attention owing to their robust conductivity, presence of favorable surface-functional groups and excellent hydrophilicity. Herein, a simple solution-based approach was adopted to functionalize few-layer thick MXene-Ti3C2Tx with chitosan (Chi) molecules, creating a stable electro-active screen-printed electrode (SPE) platform for the detection of sarcosine (SAR), a new biomarker for prostate cancer. In comparison to pristine MXene, the chitosan-functionalized Ti3C2Tx (MX-Chi/SPE) offered favorable surface functionalization for easy immobilization of sarcosine oxidase (SOx) enzymes, which led to the improved enzymatic oxidation of SAR. The detection mechanism relied upon the efficient reduction of enzymatically produced H2O2 over MX-Chi/SPE, enabling selective detection of SAR both in low (0.1–0.3 µM) and high (1.5–3.5 µM) concentration ranges, with an estimated limit of detection (LOD) values of 0.012 µM and 0.14 µM (S/N = 3), respectively. Due to its robust enzymatic configuration, the biosensor enabled selective detection of SAR even in the presence of interfering species like ascorbic acid, uric acid, and glucose. Furthermore, the biosensor demonstrated excellent signal repeatability and stability and effectively recovered spiked SAR levels (98–106%) from artificial urine samples. This approach demonstrated the successful integration of MXenes as redox-active materials in clinical biosensors with a simple electrode preparation procedure, which has the potential to be extended to other MXene compositions.