Prostate cancer is a major health problem for U.S. men and is characterized by paradoxes and controversies. Despite the wide availability of the prostate-specific antigen (PSA) test, prostate cancer screening remains a controversial practice mainly because the direct impact of screening on mortality is not yet proven. As the relative value of screening, early detection, and treatment strategies continue to be debated, glaring racial-ethnic disparities persist with African American men experiencing excess morbidity and mortality and demonstrating the lowest screening rates among racial-ethnic groups. Given the prevailing controversy, uncertainty, and known disparities, how can health education messages be framed to assist men and their family members? This article highlights the ethnic disparities, paradoxes, and controversies of prostate cancer and identifies critical challenges and opportunities for health educators and clinical practitioners. Implications for health promotion communications and informed decision making in this era of uncertainty are discussed.