Following the introduction of prostate-specific antigen (PSA) testing in the United States (US), fatal prostate cancer incidence declined between 1995 and 2002 at an average rate of 5% per year.1 Defined as death from the disease within 10 years of diagnosis, ‘fatal prostate cancer’ represents a non-indolent subset of the disease that is less sensitive to lead time bias in descriptive epidemiology studies2 and allows investigators to better track incidence trends alongside contemporary clinical practices. This evidence concerns the gene KLK3 and prostate carcinoma.