In the United States, extensive use of prostate-specific antigen (PSA) for early detection of prostate cancer prostate cancer was responsible for a steady increase in the incidence of clinically and pathologically localized prostate cancer for more than a decade, with the incidence of locally advanced or metastatic disease steadily declining (1). The massive impact of PSA on the presentation of prostate cancer has caused concerns of overdetection and initiation of unnecessary treatment for so-called clinically insignificant prostate cancer. Recently, a decrease in prostate cancer incidence was noted, and today the incidence is only minimally higher than that seen in the pre-PSA era (2), suggesting that PSA is effective as a screening tool. An effective screening tool will increase the detection of a certain disease; however, the incidence should decrease over time, if significant disease is detected through that screening method. If, however the incidence does not decline, it is possible that insignificant disease may be detected.