Importance: US guidelines recommend that physicians engage in shared decision-making with men considering prostate cancer screening. Objective: To estimate the association of decision aids with decisional outcomes in prostate cancer screening. Data sources: MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL were searched from inception through June 19, 2018. Study selection: Randomized trials comparing decision aids for prostate cancer screening with usual care. Data extraction and synthesis: Independent duplicate assessment of eligibility and risk of bias, rating of quality of the decision aids, random-effects meta-analysis, and Grading of Recommendations, Assessment, Development and Evaluations rating of the quality of evidence. Main outcomes and measures: Knowledge, decisional conflict, screening discussion, and screening choice.