Most recommendations for treatment of patients with prostate cancer category T1a–T1b is based on previous experience that patients with very lowvolume cancer—T1a—do very well in terms of progression and risk of dying of prostate cancer, whereas patients with larger tumour volume— T1b—are more like T1c or even T2 tumours. Thus, patients with T1a tumours often are recommended conservative management, whereas those with T1b tumours more often receive active treatment with curative intent. However, given enough time, some patients with T1a tumours die of prostate cancer. In this issue of European Urology, Capitanio et al [1] present data on factors predictive for the outcome of these patients, possibly indicating who will or will not progress, and review the present evidence in this field. T1a–T1b prostate cancers also are called incident tumours, ie, tumours found in the specimens of men undergoing surgery for benign prostatic hyperplasia (BPH). The 2002 Union Internationale Contre de Cancer (UICC) classification [2] defines T1a as ‘‘tumour incidental finding of 5% or less of tissue resected’’ and T1b as ‘‘if more than 5% tumour is found.’’ To which category each patient is designated is, to some extent, reliant upon the subjective judgment of the pathologist assessing the slides. Although (and in analogy with T1c) this is a pathological diagnosis and categorisation, the stage is designated as clinical stage, not pathological (pT) stage. Due to the lack of sufficient tissue to assess pT stage in the T1 category after surgery for BPH, no pT1