Prostate cancer incidence trends since the advent of prostate-specific antigen (PSA) screening have consisted of a dramatic sequence of ups and downs (Figure). The rapid adoption of PSA screening beginning in the late 1980s led to age-adjusted prostate cancer incidence rates doubling by the early 1990s. Then, as PSA screening use stabilized and the pool of latent prostate cancer cases in the population was depleted, incidence declined. A second, smaller rise in incidence peaked in the year 2000, perhaps driven by the dissemination of extended biopsy procedures.