In recent decades, prostate cancer has emerged as one of the most common diseases among older men, particularly in Western society. Several years ago, only age, race, and family history were known risk factors for this disease. However, today, much progress has been made towards discovering nutritional and hormonal risk factors for prostate cancer. Biomarkers, including testosterone and insulin-like growth factor, and nutritional factors, especially meat, fat, and dairy intake, have been linked to greater risk of disease. Higher consumption of selenium and vitamin E, fructose/fruits, and tomatoes all have been associated with reduced occurrence of prostate cancer, but as yet their efficacy for prevention remains unproven. The challenge of understanding the enigmas of this disease will continue into future decades, as we convert current knowledge into preventive and therapeutic recommendations.