Prostate cancer (PCa) is the most widespread solid organ malignancy in males and ranks as the fifth leading cause of death globally. Identifying and treating men with clinically significant disease while avoiding the over-diagnosis and over-treatment of indolent disease remains a significant challenge. Several professional associations have developed guidelines on screening and early diagnosis of asymptomatic men with prostate-specific antigen testing. With recent updates from several large randomised prospective trials, the South African Urological Association and the Prostate Cancer Foundation of South Africa have developed these evidence-based recommendations to guide clinicians on PCa screening and early diagnosis for South African men.