The report by Bill-Axelson et al. challenges current paradigms for diagnosis and treatment of prostate cancer. Contemporary dogma based on 8-year outcomes holds that early diagnosis and treatment improve survival, but after 12 years' follow-up, this study showed no significant difference in overall survival between men randomly allocated radical prostatectomy and those managed with observation. A modest improvement in prostate-cancer-specific survival was only observed in men with a Gleason score of > or =7 who were <65 years of age at diagnosis. After a lead time of 6 years' follow-up, recurrence rates in the radical prostatectomy group were equivalent to those in the observation group. Men diagnosed as having prostate cancer as a result of PSA testing are most likely to benefit from surgery if they have a Gleason score of > or =7 and are aged < or =60 years at diagnosis. Men with a Gleason score of < or =6, especially those >65 years old, are probably best served by active surveillance.