Metabolic syndrome (MetS) results from dietary caloric excess and a sedentary lifestyle and requires presence of any three of the five metabolic risk factors which are in short obesity, elevated serum trigycerides, reduced serum high-density lipoprotein-cholestrol, elevated blood pressure and elevated fasting glucose. The association between MetS and prostate cancer (PCa) has been an area of research in recent years. Possible mechanisms that are implicated for this association are perturbations in cellular signaling systems, and derangements in circulating levels of biologic mediators and hormones. Bhindi and coworkers from Canada have evaluated the association between the individual MetS components and the odds of PCa diagnosis, clinically significant PCa, and high-grade PCa in a cohort of 2235 Canadian patients referred for biopsy. No individual MetS component was independently associated with PCa. However, increasing number of Mets components was associated with higher probability of PCa, clinically significant PCa and high grade PCa diagnosis. Although this is a retrospective study and the information on patients’ hormonal milieu was not available, it improves our knowledge on the association of MetS and PCa by suggesting that there is a continuum of risk with MetS rather than an “all-or-none” phenomenon. The question whether the presence of MetS should change current PCa assessment and biopsy indications is yet to be found.