Abstract The follow-up required for patients with prostate cancer is critically dependent upon the stage of disease and the ultimate goal for treatment. A major difficulty in follow-up in prostate cancer is the lack of data on outcome of various treatment modalities. Additionally, there is a lack of data on the use of treatment modalities early in the course of prostate cancer. Despite these limitations, there is a need to develop an approach to follow these patients pending further study. In this review, we critically assess the natural course of untreated prostate cancer, the complications of local therapy, and the controversy over early versus delayed hormonal therapy. As a result of this discussion, common themes emerge. Most patients diagnosed with prostate cancer die of causes other than prostate cancer such as cardiovascular disease and therefore require additional follow-up. Since patients experience local problems such as urinary obstruction more commonly than symptomatic metastatic disease, instruments to assess urinary symptoms are discussed. Finally, follow-up as a means to determine eligibility for clinical studies is discussed.