Prostate cancer (PCa) remains the most common, noncutaneous human malignancy with an estimated 186,320 new cases for 2008 in the USA. It is also the second most lethal tumor among men, with 28,660 expected deaths in 2008 [1].

Currently, the American Urological Association along with the Veterans Administration, American Academy of Family Physicians, the American Cancer Society, the American College of Physicians – American Society of Internal Medicine and the US Preventive Services Task Force recommend avoiding PCa screening in men with an estimated life expectancy of less than 10 years. However, in real practice, this approach remains extremely controversial. While some urologists advocate screening after the age of 70 years or recommend that biopsy for men with a prostate-specific antigen (PSA) level with a routine threshold (<4 ng/ml) is not worthwhile, other investigators search in-depth for specific features of development in this cohort of patients to adjust new data and PSA cutoffs according to concrete age. An even more contentious topic, assuming one is in favor of screening, is determining when it is reasonable and prudent to discontinue screening. At the same time, in the USA, predictions indicate that the population of people aged 65 years and older will rise to 21% by the year 2050 [101]. The number of people in the 65–84 years-old age group is expected to increase by over 100%, and those in the 85 years and over age group will increase by approximately 400%. This same trend is expected in other countries all over the world. Therefore, we need to pay much more attention to this quickly rising cohort of patients as part of a bigger healthcare problem, especially regarding the increased risk of age-related diseases. Furthermore, some patients with newly diagnosed advanced disease may require palliation if they are symptomatic, with a lifespan of less than 10 years. All of this, along with the announcement of an era for individual treatment approaches in oncology at the recent American Society of Clinical Oncology meeting, drives us to re-evaluate our traditional conservative attitude to this problem...