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The use of prostate-specific antigen (PSA) testing for prostate cancer screening has increased dramatically over the past decade. Determining the most efficient way to use PSA testing and how to interpret total PSA levels and changes in PSA values over time remain challenging. Guidelines for early detection of prostate cancer have a direct impact on the number of unnecessary tests performed and are critical for developing a successful screening approach for prostate cancer. The age at which PSA screening should begin, PSA testing intervals, and the importance of understanding fluctuations in PSA values over time are discussed in the framework of recent discoveries in the field. Results from ongoing randomized trials will confirm whether prostate cancer screening is an effective method for reducing deaths from prostate cancer and what approaches will provide the most cost-effective screening strategies.

Prostate-specific antigen (PSA) velocity predicts the presence of prostate cancer on biopsy and a greater risk of prostate cancer death after radical treatment. A new variation on PSA velocity called the risk count was recently shown to provide incremental reclassification for intermediate to high-grade disease on biopsy beyond PSA and age. These markers therefore have the potential to reduce overdiagnosis and overtreatment of indolent prostate cancer, and several professional guidelines support the use of PSA kinetics along with other predictors as part of the diagnostic algorithm. Among men already diagnosed with prostate cancer, PSA kinetics may also be helpful in predicting prognosis after definitive therapy.