Advanced prostate cancer diagnoses are rising despite available screening tools—a 6% annual increase in stage 4 cases since 2012 guideline changes. Peter explains why PSA testing has evolved into a powerful early detection strategy using velocity tracking, MRI, and advanced biopsies, while revealing critical flaws in the data that led to current guidelines and how finasteride masks cancer warning signs. PSA velocity—tracking PSA changes over 18 months—is far more informative than single snapshots, with sustained increases of 0.35-0.75 ng/mL per year signaling need for further investigation. Stage 4 prostate cancer has only 38% five-year survival versus 99% for stages 1-3, making early detection the determining factor in life and death outcomes.