Objectives To develop a consensus statement on current best practice of active surveillance (AS) in the UK, informed by patients and clinical experts. Subjects and Methods A consensus statement was drafted on the basis of three sources of data: systematic literature search of national and international guidelines; data arising from a Freedom of Information Act request to UK urology departments regarding their current practice of AS; and survey and interview responses from men with localized prostate cancer regarding their experiences and views of AS. The Prostate Cancer UK Expert Reference Group (ERG) on AS was then convened to discuss and refine the statement. Results Guidelines and protocols for AS varied significantly in terms of risk stratification, criteria for offering AS, and protocols for AS between and within countries. Patients and healthcare professionals identified clinical, emotional and process needs for AS to be effective. Men with prostate cancer wanted more information and psychological support at the time of discussing AS with the treating team and in the first 2 years of AS, and a named healthcare professional to discuss any questions or concerns they had. The ERG agreed 30 consensus statements regarding best practice for AS. Statements were grouped under headings: ‘Inclusion/Exclusion Criteria’; ‘AS follow‐up protocol’ and ‘When to stop AS’. Conclusion Significant variation currently exists in the practice of AS in the UK and internationally. Men have clear views on the level of involvement in treatment decisions and support from their treating professionals when receiving AS. The Prostate Cancer UK AS ERG has developed a set of consensus statements for best practice in AS. Evidence for best practice in AS, and the use of multiparametric magnetic resonance imaging in AS, is still evolving, and further studies are needed to determine how to optimize AS outcomes.

PROSTATE CANCER IN THE UKProstate cancer became the most common cancer diagnosed in males in the UK in 2018, with around 52 300 new cases. 1 The COVID- 19 pandemic impacted prostate cancer diagnoses more than any other tumour type and up to 14 000 fewer prostate cancer cases were detected in the first 2 years of the pandemic than would be expected based on long-term trends. 2,3 This was thought to be in part due to fewer patients coming forward to their GP with symptoms warranting an urgent suspected cancer ('2-week wait') referral or to discuss opportunistic prostate-specific antigen (PSA) screening. Early-stage diagnosis (stage I/II) of clinically significant prostate cancer is crucial for improving outcomes for patients with prostate cancer. Five-year survival for patients with prostate cancer diagnosed at stage I or II is close to 100%, whereas for patients diagnosed at stage IV, around 50 out of every 100 men -around 50% -will survive their cancer for 5 years or more after they are diagnosed. 4 The delays in prostate cancer diagnosis for thousands of patients as a result of the pandemic could have significant long-term effects. This will make achieving the NHS Long Term Plan aim of diagnosing 75% of patients with early-stage cancer by 2028 all the more difficult. 5 The vast majority of patients with prostate cancer are diagnosed following a referral from their GP. Over half of these patients are referred via the 2-week wait pathway, and another quarter following a routine GP referral to urology. 6 Prostate cancer diagnoses following emergency presentation are an uncommon occurrence. 6 Prostate cancer is usually suspected in primary care with either an abnormal digital rectal examination (DRE) of the prostate or an elevated PSA level. The presence of one of these clinical features is an indication for a 2-week wait referral according to National Institute for Health and Care Excellence (NICE) guidance 12 (NG12).