To determine if the practice of active surveillance for prostate cancer (PCa) at the District General Hospital (DGH) level produces outcomes in keeping with those published from clinical trials.

A cohort of 47 patients started on active surveillance for prostate cancer in 2002–2003.

Retrospective review of case notes, electronic records and the regional cancer register.

This cohort of patients had significantly higher disease-specific mortality and greater progression to palliative forms of management compared to previously published studies.

The implementation of AS in routine clinical practice may be inconsistent, potentially leading to compromised patient outcomes.