Prostate cancer diagnosis and treatment rates have increased significantly since the introduction of prostate-specific antigen (PSA) screening. Although it was initially thought that most prostate cancers would lead to death or significant morbidity, recent randomized trials have demonstrated that many patients with screening-detected cancer will not die of their disease. Modifications to PSA screening, screening guideline statements, and novel screening markers have been developed to minimize the risk and morbidity associated with overdiagnosis and overtreatment. Less aggressive management strategies such as active surveillance may lead to lower treatment rates in men who are unlikely to benefit while maintaining cure rates.