Changes in practice guidelines for prostate cancer screening has had a major impact on the treatment of localized prostate cancer, and amplified the importance of shared decision making between patients and health care providers. In addition, the approach to the treatment of men with prostate cancer continues to evolve with the emergence of new data on both surgical and medical management. As a result, it has become an ever-increasing challenge to ensure shared decision making between providers and patients, particularly in the context of relatively constrained office visits.