Using the Long Beach Veterans Hospital database, Jane Cho, MD, and colleagues at the University of California Irvine identified 762 men diagnosed with PCa, of whom 261 (34.3%) died at a mean follow-up of nine years. Of these, 186 (71.3%) had complete follow-up data available. Forty-one (22%) of these men died from metastatic PCa, and 28 (68.3%) of them had presented with metastatic disease. Eight (28.6%) of these men had no previous PSA measurement recorded. The median survival of men who presented with metastatic PCa was significant shorter than that of men who developed metastatic disease (595 vs. 1,044 days). In addition, among 12 men older than 75 years who presented with metastatic PCa, 11 91.7%) died of PCa despite being at higher cardiovascular risk.