OBJECTIVES:   Controversy exists regarding the clinical and economic value of prostate cancer (PCa) screening. Our objective is to summarize cost-effectiveness studies on Pca screening with PSA. METHODS:   We systematically searched the English-language literature for cost-effectiveness analyses (CEA) on PSA screening programs published between 1994-2009 using Medline and other databases. We collected data related to methods, screening population, screening strategies, and reporting of results. RESULTS:   We identified 10 CEA in PCa screening using PSA, 30% of the studies investigated efficacy of PSA on PCa detection, and 70% for efficacy of PSA on both PCa detection and consequent treatments. All studies were based on either decision tree (60%) or Markov models (40%). Majority of studies only modeled single-episode screening (80%). The screening population included men age 40-79 years old, high PCa risk sample, or Medicare population. Four types of screening strategies were compared: 1) no screening vs. PSA, or PSA combined with digital rectal examination (DRE); 2) different thresholds of normal PSA; 3) isoforms of PSA (PSA, free PSA, complexed PSA); 4) different screening intervals. Method of cost-effectiveness measures varied from studies. Outcomes were presented as costs/quality adjusted life years (QALY) (30%), costs/life-years saved (40%), costs/curable cancers (20%), costs/detected cancer (10%). Only five studies originated in U.S. As compared to no screening, four studies reported an incremental cost-effectiveness ratio for screening with PSA or combined with DRE that ranged from $12,502 to $65,909/life-year saved in Medicare population aged 65-69 years, and general population aged 70-79 years, respectively. One study reported that PSA- alone screening was dominated by no screening in the general population aged 50-79 years. CONCLUSIONS:   Economic evaluation of PSA in Pca screening remains limited. Cost-effectiveness ratios reported from studies varied from screening populations, calendar year, and country original, which made the comparisons difficult.