Wheeler et al. BMC Cancer 2011, 11:148 http://www.biomedcentral.com/1471-2407/11/148 knowledge on screening, and to protect them from making rash, uninformed decisions with the potential for signifi- cant harm while maintaining personal freedom of choice. We hope definite evidence will emerge and that improved methods may eventually be able to differenti- ate between high-grade prostate cancer and clinically harmless disease, rendering a libertarian paternalistic approach for PSA screening unnecessary. In the interim however, while PSA screening remains controversial and evidence conflicting, this approach to decision-making can help prevent the overdiagnosis and overtreatment of prostate cancer. Author details 1Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. 2Division of Urology, McGill University Health Centre, Montreal, QC, Canada. 3Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA. 4Cancer Prevention Fellowship Program Branch, Center for Cancer Training, National Cancer Institute, Bethesda, MD 20892, USA. Authors’ contributions DCW drafted the manuscript. All authors contributed to and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 2 November 2010 Accepted: 21 April 2011 Published: 21 April 2011 References 1. What are the key statistics about prostate cancer?. [http://www.cancer. org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-key-statistics]. 2. 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