The US Preventive Services Task Force (USPSTF) analyzed the benefits and harms of prostate specific antigen (PSA)-based screening for prostate cancer (PCa).The Grade ‘D\' recommendation of the USPSTF was based mainly on the Prostate,Lung,Colorectal,and Ovarian (PLCO)study in the United States.That result showed only a small reduction in PCa mortality.However,the data from the International Agency for Research on Cancer (IARC) illustrated the PCa mortality rate (MR) decreased marked.To avoid the over-diagnosis and over-treatment,the American Cancer Society has changed its strategy and updated its guidance.The USPSTF neglected the aggressive PCa accounted for more then 30％ of all PCa.Highly aggressive PCa can be diagnosed by PSA screening combined with Gleason grade.We hope that the USPSTF changes the ‘D\' recommendation for PSA screening.