For many years diagnosis and management of prostatic adenocarcinoma were straightforward. However, with the advent of medical and less invasive therapies for the treatment of prostatic cancer, it has become necessary to know more about the etiology and pathophysiology of the disease. For example, hormonal factors, growth factors, stromal-epithelial interactions and aging have all been implicated in the etiology of the disease. The pathology of the disease demonstrates heterogeneity in the ratio of the stroma to the epithelium in any given patient, and the pathophysiology varies. Recognizing this heterogeneity in the disease, it is clear that no one form of medical or interventional therapy should be expected to result in a complete response.