This editorial is from the University of Minnesota in the USA. The present evidence suggests that prostate specific antigen (PSA) testing provides a small reduction in prostate cancer (CaP) mortality and no reduction in all-causes mortality. The downside is of over-diagnosis and over-treatment. Better tools are being developed such as the Prostate Health Index and the 4Kscore Test. Another recent development is the use of multiparametric MRI with the most notable study being PROMIS from the UK. The primary outcome was cancer with Gleason score 4+3 or maximum cancer length of 6mm or more in a core. Using the data from this study, 27% of men with negative mp-MRI would be able to avoid biopsy (accepting 11% false negative MRI result). Patients with suspicious MRI findings would have about a 50% chance of having significant CaP. The PRECISION trial is currently underway. Any screening tool which can reduce the need for prostate biopsy will be a big step forward for men all over the world.