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The diffusion of early detection of prostate cancer with the prostate-specific antigen (PSA) test and subsequent aggressive treatment for the cancers discovered, in the absence of randomized trials documenting such screening efforts do more good than harm, has been nothing short of remarkable in the United States. The decade of the 1990s in this country might appropriately be referred to as the "PSA era." The medical and social reasons for the success of this strategy are complex. They include a captivating pathophysiologic rationale, "proof of concept" that early detection saves lives with screening for breast cancer in women, economic incentives for physicians and industries involved with testing and treatment, medicolegal concerns relating to failure to diagnose prostate cancer, positive feedback from grateful patients who feel reassured based on their test results, and even stronger positive feedback from prostate cancer survivors who are sure they have "beaten cancer" as a result of early detection--many of whom would never have even known they had prostate cancer in the "pre-PSA" era. Even the U.S. Postal Service has gotten into the business of screening recommendations in this area with a 1999 postage stamp urging "Annual Check-Ups and Tests" for prostate cancer. [ABSTRACT FROM AUTHOR]