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Routine testing for prostate cancer is not recommended for most men because the benefit is small and uncertain, and there are clear harms, according to a panel of international experts in The BMJ. But they acknowledge that some men, such as those with a family history of prostate cancer, may be more likely to consider screening, and for this group, discussing possible harms and benefits with their doctor is essential. An international panel including clinicians, men at risk of prostate cancer, and research methodologists undertook a detailed analysis of the latest evidence, applying the GRADE system for assessing its quality. A review including more than 700 000 men in clinical trials found that the benefit of screening for reducing prostate cancer-related deaths is at best very small. Accordingly, the panel advised against offering routine prostate-specific antigen (PSA) screening, noting that most men decline screening because the benefits are small and uncertain and the harms are clear. Clinicians need not feel obliged to systematically raise the question with all their patients, and should engage in shared decision-making for those considering screening. A linked editorial pointed to recent advances in active surveillance, “which have the potential to reduce the harms of testing”. In the meantime, the experts suggest that conversations with patients requesting a PSA test “should explore their reasons for requesting a test, and include evidence-based discussions about possible harms and benefits of PSA testing, informed by the patient’s ethnicity and family history”.