Traditionally, prostate cancer was considered a disease of "older men." As such, it was generally accepted that "men never died from prostate cancer, they died of other conditions with prostate cancer." Consequently, treatment was conservative and directed toward palliation and prevention of the emergence of debilitating and painful sequelae. In addition, diagnosis was generally made on the basis of palpating a rock-hard and nodular prostate on digital rectal exam [DRE] or by symptoms and signs of primary or secondary tumors, such as urinary obstruction, back pain, nerve root or, less commonly, spinal cord compression. Almost invariably, most tumors had already disseminated at the time of diagnosis and, therefore, were incurable. It was in the mid-1980s, with the introduction of the PSA blood test that prostate cancer began to be diagnosed earlier and in younger men.

Although methods of diagnosis and treatment of localized disease have become well-established, the management of prostate cancer remains controversial due to its variable biologic course, imprecision with clinical staging and limitations in prediction of the clinical outcome of patients with both organ-confined and locally-invasive disease - not to mention the morbidity associated with all currently established treatments. It is sobering to muse that, were the unwanted effects of diagnosis and treatment insignificant, the dilemma of whether or not to treat would not be an issue.