Driven by the pressure of increasing use of PSA screening, cancer diagnosis based on histopathology has been constantly improved. When appropriate quality standards for obtaining a biopsy specimen and for tissue preparation are upheld, even the smallest tumour foci can be identified with certainty. Efforts to standardize the Gleason grading should also help to render assessments of tumour biology more precise. In addition, subtle diagnosis of precancerous or cancer-associated lesions will permit more exact prognoses of existing cancer risk to be made. There are still weak points: reliable recognition of clinically insignificant carcinomas and the danger of overtreatment. Further research activity on this topic is needed.