In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a blanket "D" recommendation against all prostate-specific antigen (PSA)-based early detection efforts for prostate cancer, reflecting critical misinterpretations of the major evidence regarding benefits and harms of such testing. Against the backdrop of the ensuing controversy, in 2013 the American Urological Association (AUA) published a new, methodologically rigorous guideline. This guideline recommended that men aged 55-69 be offered biennial screening in the setting of shared decision-making, that men under 40 or over 69 years of age should not be screened routinely, and that evidence was insufficient to recommend screening for men aged 40-54 years. While it has received criticism with regard to the age-based recommendations, the AUA guideline reflects a far better and more balanced presentation of the available evidence than the USPSTF statement. However, because the USPSTF is far more influential than the AUA among primary care providers, the ultimate impact of the new AUA guideline on practice patterns may be limited. Optimizing early detection practices should involve consensus-building incorporating both primary care and specialist input, with the goals of minimizing overtreatment of low-risk disease while continuing to reduce prostate cancer mortality rates through early detection and aggressive management of high-risk disease.

Recent evolution of prostate cancer treatment reflects technological arms races driven by economic incentives rather than high-quality evidence - as exemplified by proton-beam radiation, recently found markedly inferior to far less-expensive alternatives. Another study found promise for focal treatment, but much research is required before this could become a standard option. © 2012 Macmillan Publishers Limited. All rights reserved.