OBJECTIVES: To assess the impact of not screening for prostate cancer among a hypothetical population of men > 55 years of age. METHODS: Sample included PLCO Screening Trial intervention participants without cancer at T0 (n=33,709) through 2011. Inclusion criteria: age ≥ 55 years, and adequate PSA or DRE exam at entry. Cancer was considered clinically significant if patient had confirmed PCa with Gleason score  ≥ 7.   Estimated PCa expenditures were based on Medicare costs. Results were projected to SEER incident population (n=202,500 with localized cancer). RESULTS: Among 2,580 PLCO men identified and treated for PCa after T0, estimated total expenditures were: $61.5 million, with $23,804 per treated patient. Among 377 PLCO men with clinically significant cancers who received treatment, estimated total expenditures were $8.6 million (mean, $22,742 per patient).  Among 549 PLCO men with clinically non-significant PCa identified and treated after T0, estimated total expenditures were $13.6 million ($24,831 per case). Extrapolated nationally to 96,000 clinically significant PCas annually, annual initial diagnosis/ treatment costs would be $2.4 billion. Adopting draft USPHSTF recommendations would result in $2.4 billion in initial savings ($23,804/patient). Many of these men will subsequently present with clinically significant PCa, will require systemic therapy, and will die from PCa, with total costs far exceeding $2.4 billion. CONCLUSIONS: The 2011 USPHSTF Task Force draft policy currently grades PCa screening as “(D)-  do not discuss with patients.” A more rational policy would be to screen appropriate men for PCa and to treat early clinically significant PCa with surgery or radiation.