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.