Over recent years there has been an increasing awareness that our ideas on the lethality of primary non‐metastatic prostate cancer may need to change. This concept has emerged from a number of different sources including randomised controlled trials, reports from mature active surveillance programmes, and prognostic modelling work in large populations 1, 2. The evidence suggests that for many men without metastatic disease (85% of all presentations from the recent UK National Prostate Cancer Audit) tumours will evolve slowly and will not translate into cancer‐related mortality, at least, not within the first 10–15 years of its natural history.