Admittedly not a perfect test, PSA screening has led to a consistent decrease in prostate cancer mortality (Cancer Facts & Figures 2015. Atlanta: American Cancer Society. 2015). The stage migration created by PSA testing has allowed many men with prostate cancer to seek treatment much sooner than they would have otherwise, significantly decreasing the proportion of men who present with metastatic disease and allow for a potential cure for prostate cancer patients. This benefit has not been experienced with other prevalent cancers with approved screening protocols (N Engl J Med. 2015 Oct 29;373(18):1685-7). Since the USPSTF downgraded PSA screening to a grade D recommendation in May of 2012(Ann Intern Med. 2012;157(2):120-134), we have already started to see an increase in the number of patients who present with metastatic disease. If CMS penalizes providers for performing PSA tests, we are likely to see a reversal of the progress made in prostate cancer mortality in the United States over the last 20 years.