This study provides frequencies of downstream outcomes during the 5 years following an abnormal screening prostate-specific antigen (PSA) result among men 65 years and older in clinical practice. The percentage of men with a screening PSA level above 4 ng/mL increased with age, but only one-third of men underwent biopsy. Receipt of biopsy decreased with advancing age and comorbidity, whereas biopsy detection of prostate cancer increased with age. Most men with biopsy-detected cancer received immediate treatment, regardless of advancing age, poor health, or low-risk cancer. Among those treated, 5-year survival was high but decreased with advancing age and comorbidity, whereas deaths from nonprostate cancer causes increased. Decisions to pursue PSA screening should include discussion about when to pursue biopsy and treatment and the likely outcomes of these interventions according to baseline characteristics to better individualize these decisions.