The American Urological Association (AUA) published a guideline on early detection of prostate cancer, focusing on asymptomatic men at average risk. The guideline aims to provide urologists with a framework for decision-making regarding prostate cancer screening. A systematic review of over 300 studies was conducted, evaluating the outcomes of interest, including prostate cancer incidence, mortality, quality of life, diagnostic accuracy, and harms of testing. The evidence was interpreted from the perspective of the individual patient, considering their values and preferences rather than public health perspectives. The guideline recommends shared decision-making for men aged 55 to 69 years considering PSA-based screening, as the benefits may outweigh the harms in this age group. For men under 40 years, the guideline recommends against PSA screening due to low prevalence of clinically detectable prostate cancer and lack of evidence for benefit. For men aged 40 to 54 years, routine screening is not recommended, as the benefits are minimal and the harms are significant. For men over 70 years or those with a life expectancy of less than 10 to 15 years, routine PSA screening is not recommended due to the high risk of over diagnosis and over treatment. The guideline suggests that screening intervals of two years or more may be preferred over annual screening to reduce harms. Modeling studies indicate that longer intervals can preserve the majority of benefits while reducing over diagnosis and false positives. The guideline also emphasizes the importance of shared decision-making, considering individual values, preferences, and quality of life goals. The evidence for the benefits of PSA screening is moderate, while the evidence for harms is high, particularly in men aged 55 to 69 years. The guideline acknowledges the limitations of the current evidence and the need for further research to clarify the balance of benefits and harms in different populations. The AUA emphasizes that the guidelines are not absolute mandates but provisional proposals for treatment under the specific conditions described. Physicians are encouraged to consider individual patient factors and make informed decisions based on the available evidence.The American Urological Association (AUA) published a guideline on early detection of prostate cancer, focusing on asymptomatic men at average risk. The guideline aims to provide urologists with a framework for decision-making regarding prostate cancer screening. A systematic review of over 300 studies was conducted, evaluating the outcomes of interest, including prostate cancer incidence, mortality, quality of life, diagnostic accuracy, and harms of testing. The evidence was interpreted from the perspective of the individual patient, considering their values and preferences rather than public health perspectives. The guideline recommends shared decision-making for men aged 55 to 69 years considering PSA-based screening, as the benefits may outweigh the harms in this age group. For men under 40 years, the guideline recommends against PSA screening due to low prevalence of clinically detectable prostate cancer and lack of evidence for benefit. For men aged 40 to 54 years, routine screening is not recommended, as the benefits are minimal and the harms are significant. For men over 70 years or those with a life expectancy of less than 10 to 15 years, routine PSA screening is not recommended due to the high risk of over diagnosis and over treatment. The guideline suggests that screening intervals of two years or more may be preferred over annual screening to reduce harms. Modeling studies indicate that longer intervals can preserve the majority of benefits while reducing over diagnosis and false positives. The guideline also emphasizes the importance of shared decision-making, considering individual values, preferences, and quality of life goals. The evidence for the benefits of PSA screening is moderate, while the evidence for harms is high, particularly in men aged 55 to 69 years. The guideline acknowledges the limitations of the current evidence and the need for further research to clarify the balance of benefits and harms in different populations. The AUA emphasizes that the guidelines are not absolute mandates but provisional proposals for treatment under the specific conditions described. Physicians are encouraged to consider individual patient factors and make informed decisions based on the available evidence.