This chapter deals with a case study of a 56-year-old white male with no past medical history. He visits his primary care physician for his yearly physical. His exam and laboratory results are negative with the exception of an elevated prostate serum antigen (PSA) level at 8 ng/mL (normal <4 ng/mL). Prostate biopsy is scheduled. Based on this case, the chapter analyzes whether standard PSA screening is necessary for an asymptomatic patient with a normal digital rectal exam. The primary goal of PSA-based screening is to find men in whom treatment would reduce morbidity and mortality. Next, the chapter talks about active surveillance. The aim of active surveillance is to identify low-risk or clinically insignificant prostate cancer that, if untreated, would not pose an immediate threat to the patient. Finally, the chapter discusses the need for biopsy or local radiotherapy.