The USPSTF recommendation against regular prostate specific antigen screening for prostate cancer has been in place for 2.5 years. Although the number of prostate needle biopsies (PNB) has been reduced, patients who undergo PNB are significantly more likely to be diagnosed with high risk disease, and detection of intermediate risk, potentially curable PCa has likely decreased. While ‘over diagnosis’ and ‘overtreatment’ may have been impacted, there is concern that diagnosis of treatable cancers will be delayed.