The goal of prostate cancer screening is to detect patients with tumors early so that they can be treated more effectively. Since the introduction of prostate cancer screening, prostate cancer mortality has decreased, but it is unclear whether this decrease is a direct result of screening or due to other causes (e.g., improved treatment techniques). Preliminary results from two prospective, randomized studies were published in 2009: the European Randomized Screening Study for Prostate Cancer (ERSPC) and the Prostate Cancer in the Prostate, Lung, Colon, and Ovarian Cancer Screening Trial (PLCO) in the U.S. The ERSPC study demonstrated that prostate cancer screening reduced prostate cancer-specific mortality by 20% compared to controls. However, the PLCO study did not show that screening reduced prostate cancer mortality. Although there is uncertainty about whether patients will benefit from prostate cancer screening, it is known that the burden of early detection and treatment of prostate cancer is significant. Moreover, overdiagnosis and overtreatment of prostate cancer is more of a problem than for other tumors. In addition, the side effects of prostate cancer treatment are severe and can be life-threatening. The large body of research available on the early detection of prostate cancer does not support either mandatory prostate cancer screening or a ban on prostate cancer screening. For this reason, beginning in 2009, the ACS Prostate Cancer Advisory Committee began work on updating the Guidelines for Early Screening for Prostate Cancer. Experts conducted a systematic review of a series of studies that focused on early screening for prostate cancer, test performance, the harms of localized prostate cancer treatment, and patient informed consent. After evaluating and considering the results of these studies, the Prostate Cancer Advisory Committee was formed and began drafting guidelines, which were reviewed and revised by committee members and experts, and finally the new version was adopted at the ACS Representative Council and the ACS Board of Directors. Recommendation 1 of the 2010 version of the guideline: “Those who have the opportunity to decide whether to undergo prostate cancer screening should be asymptomatic men with at least 10 years of expected survival, and they must understand the uncertainties, risks, and potential benefits associated with prostate cancer screening before making a joint decision with their physician about whether to undergo prostate cancer screening.” The decision making process must be communicated to patients prior to the decision to screen for prostate cancer: at age 50 for men with moderate risk factors for prostate cancer (intermediate risk group) and at age 45 for men with high risk factors for prostate cancer (high risk group), such as African Americans and first-degree relatives (father or brother) who have developed prostate cancer before age 65. Men who are at significantly increased risk for prostate cancer (very high risk group), such as multiple family members who have prostate cancer before age 65, should be made aware at age 40; and for those men who cannot make their own decisions, physicians should make a careful decision about prostate cancer screening after considering the patient’s health preferences and values. ”Asymptomatic men with an expected survival of less than 10 years after an age and health status assessment should not be screened for prostate cancer.” For men who are 75 years of age or older, only about half of them have a life expectancy of 10 years or longer. People in this age group who have a combination of serious coexisting conditions will not benefit from prostate cancer screening. People younger than 75 years of age with coexisting conditions that affect survival, such as congestive heart failure (New York Heart Failure Class 4), moderate to severe chronic obstructive pulmonary disease, advanced kidney disease, moderate to severe dementia, or lethal tumors, also do not benefit from prostate cancer screening. Therefore, it is important to take into account the patient’s overall health status and not just age before deciding whether to screen for prostate cancer. The 2010 version of the guideline recommends that “the patient’s own values must be used to help him or her decide whether or not to be screened for prostate cancer. Once patients understand the uncertainties, risks, and potential benefits of prostate cancer screening, the reasons for or against prostate cancer screening become very clear.” For those who decide to be screened despite having recognized the possible benefits and risks of prostate cancer screening, recommendations are shown in the chart to the right. Factors that increase the risk of developing prostate cancer include being African American, a family history of prostate cancer, increasing age and abnormal DRE test results. A negative prior prostate puncture result is associated with a decreased risk of prostate cancer. Those who choose to undergo screening may place greater importance on early detection of tumors, may be willing to undergo treatment (although there is uncertainty about the benefit of treatment), and may be willing to take the risk of urinary, sexual, and/or bowel dysfunction. Those who choose not to be screened may place a higher value on the harms associated with screening and treatment, such as anxiety or fear of urinary, bowel, or sexual dysfunction. For those who have recognized the possible benefits and risks of prostate cancer screening and still decide to undergo screening for prostate cancer: (1) screening with PSA test with or without DRE test is recommended; (2) annual screening should be considered when PSA is ≥2.5 ng/ml; (3) when PSA is <2.5 ng/ml, the screening interval can be extended to every 2 years; (4) when PSA is ≥4 ng/ml, patients are recommended to undergo further evaluation or prostate puncture biopsy, which also applies to those at intermediate risk for prostate cancer; ⑤ If 2.5 ng/ml ≤ PSA < 4 ng/ml, physicians should consider an individualized risk assessment that incorporates other risk factors for prostate cancer (especially for high-grade prostate cancer), which can be used to determine whether a Prostate puncture biopsy. Although there is still controversy about whether screening for prostate cancer reduces the burden of prostate cancer, there is consensus that there is an urgent need to improve the methods of early detection and treatment of prostate cancer. We expect that in the future, improvements in early detection of prostate cancer will accurately distinguish between inert and aggressive tumors, while allowing for a significant reduction in side effects of prostate cancer treatment. This will tip the scales of decision making to the side of prostate cancer screening. At that point, however, it will still be incumbent upon clinicians to provide patients with the information they need to decide whether they wish to undergo early detection of prostate cancer. In summary, this updated guideline emphasizes the importance of patient involvement in screening decisions, emphasizes interactive communication between physicians and patients, and fully reflects the patient's right to informed consent in the process of disease diagnosis and treatment.