(UroToday.com) Prostate cancer screening using prostate-specific antigen (PSA) testing has been controversial since shortly after its introduction in large part due to concerns of over-diagnosis and over-treatment, with the associated morbidity. Thus, despite improvements in prostate cancer-related metastasis and mortality demonstrated in the European Randomized Study of Screening for Prostate Cancer (ERSPC) randomized trial from Europe, PSA screening has remained contentious. In both 2008 and 2012, the US Preventive Services Task Force (USPSTF) did not recommend PSA screening. Some have attributed increased rates of metastatic prostate cancer in the US to reductions in PSA screening as a result of these recommendations from the USPSTF. To test this hypothesis, in the Poster Highlights: Prostate Cancer – Localized Disease Session at the 2021 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium, Dr. Vidit Sharma and colleagues assessed longitudinal variations in PSA screening across individual states with the incidence of de novo metastatic prostate cancer.