During the past three decades, we have witnessed tremendous shifts in the way that we approach prostate cancer. The introduction of prostate-specific antigen (PSA) screening dramatically altered the presentation of the disease, but we are now moving away from a “one-size-fits-all” approach to new ways of individualizing screening. Better understanding of prostate cancer biology has led to the introduction of several new agents for advanced disease, transforming what had previously been a relatively barren field. Marker research has rapidly developed, with novel genomic markers now identifying the molecular drivers of aggressive disease. We are less aggressive in our approach to low-risk disease, moving away from radical treatment toward an increased use of active surveillance, while becoming more aggressive in attempting to control high-risk tumors. Instead of administering hormonal treatment alone, we also attack the tumor-invaded organs with surgery or kill the cancer cells with radiation.

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