PSA is the best tool for prostate cancer diagnosis. The wide use of PSA with time leads to localized tumour detection with better prognostic factors. The role of PSA for screening is debatable with a doubt on the traditional cut-off of 4 ng/ml. Lowering PSA levels leads to a higher detection rate but also increases the risk of overdiagnosis. Potentially aggressive tumours can not be identified by appropriate PSA cut-off level. Even with low value of PSA < 3 ng/ml, aggressive cancers are diagnosed. The goal is to identify aggressive but still curable diseases with an acceptable accuracy. News strategies for early diagnose are reviewed with the interest of PSA for screening in 2006.