The goals are clear. New testing strategies are needed to identify men at greater risk of prostate cancer (PC) who would benefit from routine screening. Then, test development needs to focus on assays that can better distinguish men who have low-grade PC from those with aggressive, high-grade cancer—those who need a biopsy and those that can be monitored with active surveillance versus those who need immediate intervention. While the goals are universally accepted, strategies for PC screening and testing for those with suspected PC have grown increasingly murky following the United States Preventive Services Task Force’s (USPSTF’s) 2012 final guideline against prostate-specific antigen (PSA) screening. The recommendation stems from the realization that PSA screening, while possibly contributing to a trend of decreased PC mortality, was also leading to an overdiagnosis and overtreatment of low-risk, non-aggressive disease— men who would die with, but not from PC. Since the time the recommendation was made, PSA testing has definitely declined. What remains uncertain, though, is what are the best strategies to identify men at highest risk of PC who could benefit from ongoing screening, those who do not need a biopsy, and those who have lowgrade disease that can be watched, rather than […]