Prostate cancer early detection or screening is for many decades now a highly controversial topic within urology. The discussion evolves around two issues, i.e. is there convincing evidence that PSA based screening can reduce suffering and dying from the disease and how to best organize the ongoing early detection practices within clinical care. This chapter discusses all related issues and, in addition, provides suggestions on how to continue with, for example the possibility of (inter)national organized population based screening programs.