According to an editorial, while the absolute risk of second malignancy seems small, there might be subgroups with higher absolute risks and others for whom risks are negligible. It calls for prospective analyses with large multi-institutional databases and registries to identify the predisposing characteristics of patients and culpable technical factors associated with radiation associated malignancies. It notes that this analysis further supports the move towards even more tightly targeted external radiation techniques, and confirms the belief that second malignancy should be added to the already long list of avoidable hazards associated with treatment for those men with low risk prostate cancer who need no treatment at all. However, it also reiterates that concern about second malignancies should not stand in the way of an effective and well-studied treatment being given to men with higher grade, lethal prostate cancer.