As the debate continues on the merits of prostate cancer (PCa) early detection, primary care providers (PCPs), urologists, and specialists are left struggling to balance benefits from early detection and treatment of lethal PCa that justify the inherent risks of overtreatment. The 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)–based screening highlighted the limitations in the historical implementation of screening.1 Given the low specificity of PSA for clinically significant PCa in the screening setting, it is not surprising in retrospect that population-wide application with a threshold of 4.0 ng/mL defining a positive result led to overdiagnosis and overtreatment as well as many missed cancers when PSA is used alone. The longstanding underuse of active surveillance (AS) in low-risk disease and the associated harms of treatment factored strongly into these recommendations. More recent AS data suggest that the trend has shifted markedly,2-5 with increasing evidence now showing that patients can be safely monitored over a long period.