The purpose of this chapter is to describe and analyze how patents are commercialized and how the choice of commercialization mode affects performance. The emphasis is on patents that are commercialized in new start-up firms. However, throughout the chapter the new firm alternative will be compared with the other possible modes of commercialization, i.e. patents that are sold, licensed, or commercialized in existing firms, where the inventor is either owner or employed. Four aspects of new start-up firms and other modes of commercialization are described and analyzed: 1) Which owners/inventors commercialize their patents? 2) Which owners/inventors start-up new firms and which ones use other modes of commercialization? 3) How is the choice of commercialization mode related to subsequent profitability? 4) How is the mode of commercialization related to the renewal and the value of patents?