The definition of the geriatric population is somewhat variable. For the purposes of this chapter, we will define it as those aged 70 years and older. Management of prostate cancer in this population can be particularly challenging due to two inherent yet seemingly contradictory truths. Age is a risk factor for the diagnosis of prostate cancer and also for the presence of higher risk disease. However, older men with prostate cancer are at higher risk of dying from competing causes than younger men with comparable disease. Therefore, it is imperative to recognize this reality and individualize care to each particular man with age and comorbidities in mind to try to minimize both overtreatment and undertreatment of geriatric patients with prostate cancer.