Prostate cancer screening is a preference-sensitive decision. For this reason, the Panel recommends clinicians engage in SDM with people considering prostate cancer screening so they can make an informed choice. The Panel discourages the practice of ordering a PSA test without informing the patient upfront, and likewise discourages the practice of failing to inform the patient of the availability of PSA screening, as appropriate. SDM is considered state-of-the-art in patient counseling for preference-sensitive decisions.17 This practice can be facilitated using a decision aid. A 2017 Cochrane systematic review and meta-analysis of 105 studies showed that people who view decision aids feel more knowledgeable, better informed, and clearer about their values.18 A 2019 systematic review and meta-analysis of 19 RCTs evaluating decision aids specifically designed for the prostate cancer screening decision versus conventional care showed a small decrease in decisional conflict (moderate-quality evidence) and a small increase in knowledge (low-quality evidence). However, there was no association between clinician and patient discussion on prostate cancer screening or discussion on the type of screening to obtain.19 While SDM is strongly encouraged, the Panel acknowledges that downstream risks of screening of potential side-effects from curative treatment of screen-detected tumors are lower today with increased utilization of AS for low-risk disease. This is currently a practice endorsed by the AUA as a strong recommendation for patients with low-risk localized prostate cancer.20 A 2016 AUA White paper17 recommends SDM which include four key elements: <ol> <li>Involvement of both the clinician and the patient in the decision-making process.</li> <li>Sharing information by both the clinician and the patient.</li> <li>Building consensus through the expression of preferences by both clinician and patient.</li> <li>Agreement by both the clinician and patient on the decision to implement.</li> </ol>