Prostate cancer is the most common malignant tumor among men in Brazil, excluding non-melanoma skin cancer. National estimates project 82,630 new cases annually for 2023–2025, with higher incidence in the Southeast and South regions. Early detection relies on prostate-specific antigen (PSA) testing and digital rectal examination (DRE); however, universal screening is not recommended. In Brazil, adherence to preventive measures is low and uneven, influenced by cultural resistance, limited health literacy, and insufficient professional guidance.To assess adherence to preventive measures for prostate cancer in Brazil, focusing on PSA testing and digital rectal examination.A narrative literature review was conducted using PubMed, LILACS, SciELO, and the Virtual Health Library, applying MeSH/DeCS terms related to prostate cancer screening. We included Brazilian studies (2010–2025) reporting PSA and/or DRE adherence in adults.PSA adherence in Brazil ranges widely, with studies reporting 55.2% to 80.1% lifetime testing, while older adults show 75.5% prevalence. DRE adherence is consistently lower, around 61%, and a 68.3% combined PSA/DRE prevalence reflects access but not specific acceptance of DRE. Sociocultural barriers—shame, discomfort, and masculinity norms—reduce DRE uptake, whereas physician recommendation strongly supports PSA adherence and may also increase DRE acceptance. Overall, PSA adherence is moderate to high, while DRE remains moderate, and combined screening improves accuracy but faces cultural and system-level challenges.Preventive adherence in Brazil shows a clear contrast between PSA and DRE. PSA uptake is high (75.5% in older adults; 80.1% lifetime), while DRE remains lower (61.0%). Sociocultural barriers—shame, discomfort, and masculinity norms—strongly influence refusal. Physician guidance increases PSA testing and may improve DRE acceptance. The 68.3% combined prevalence reported by Meneghini et al. reflects screening access but a clear preference for PSA. Structural issues in the Brazilian Unified Health System, including limited specialist access and inconsistent referral pathways, also hinder adherence. Continuous education, shared decision-making, and organized care pathways are essential to improve screening outcomes.PSA adherence in Brazil is moderate to high, while DRE adherence remains comparatively low. Improving screening adherence requires enhanced health education, effective communication, and strengthened care pathways within primary care.