Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.