The treatment pathway for advanced prostate cancer is both puzzling and complex and varies from centre to centre in the UK. The National Prostate Cancer Audit Report 2019 for England and Wales shows that only a quarter of men with advanced prostate cancer received docetaxel chemotherapy despite its recommendation by the National Institute for Health & Care Excellence (NICE). The audit found that nearly 42,000 men were diagnosed with prostate cancer in 2017-2018. The proportion of men presenting with metastatic prostate cancer at diagnosis was 16%. Urinary complications after surgery improved from 11% to 9% from one year to next. But, bowel complications after radiotherapy remained the same at 10%. Ninety-eight percent of multidisciplinary teams (MDT) offered sexual function and incontinence services. However, less than half of radiotherapy units offered specialist gastro-intestinal services. Hypo-fractionated radiotherapy was used in 91% of intermediate cases and 59% of high risk cases. This audit report will make interesting reading for both urologists and oncologists.