Recent studies suggest that PSA screening decreased after the release of these recommendations, particularly among elderly men. Decreases in PSA testing ranging from 8% to 36% among men aged ≥75 years after the release of the 2008 guidelines are cited, along with decreases in the use of PSA testing among primary care physicians. However, data from the National Health Interview Survey (NHIS) suggest that screening rates among older men with limited life expectancy did not decrease over time and only a small proportion of these men recalled discussing the risks and benefits of PSA screening with their physician. Despite the adoption of guidelines recommending against PSA screening and the established harms associated with the overdetection and treatment of prostate cancer, it remains largely unknown whether the downstream utilization and treatments associated with PSA screening and prostate cancer diagnosis remain inappropriately high among older age groups. Therefore, the goal of this study was to determine whether the use of PSA screening, subsequent prostate biopsies, and prostate cancer treatments decreased among men aged ≥40 years from 2000 to 2012 in the large, diverse, general practice setting of Kaiser Permanente Southern California (KPSC).