V Gnanapragasam, T Barrett, C Massie, S Pacey, A Warren
Over recent years there has been an increasing awareness that our ideas on the lethality of primary non-metastatic prostate cancer may need to change. This concept has emerged from a number of different sources including randomised controlled trials, reports from mature active surveillance programmes and prognostic modelling work in large populations (1-2). The evidence suggests that for many men without metastatic disease (85% of all presentations from the recent UK National Prostate Cancer Audit) tumours will evolve slowly and will not translate into cancer related mortality, at least, not within the first 10-15 years of its natural history. This article is protected by copyright. All rights reserved.