Prostate cancer is an important health problem. Randomized trials have not yet proven whether or not screening with prostate-specific antigen measurements reduces morbidity or mortality. The potential for overtreatment of prostate cancers not destined to cause future mortality, the uncertainty about the benefits of aggressive treatment of screen-detected cancers, and the relatively high costs of prostate cancer screening programs are all areas of concern. A shared approach to decisions about screening individual patients pending better evidence is one strategy for clinicians to consider in dealing with this controversial problem.