The increasing incidence of prostate cancer stood for years as a seemingly unshakable axiom of modern medicine. Recent evidence illustrates that the incidence of prostate cancer may have peaked and raises questions about the relative meaning of prostate cancer in the future. This article reviews the many antagonistic factors that will affect prostate cancer incidence and mortality. No projections are offered about incidence and mortality, but it is believed that the number of patient-years with prostate cancer will increase and present new clinical challenges.