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A panel of 17 experts from the Asia-Pacific region reached a consensus on the clinical usefulness of protein-induced vitamin K absence II (PIVKA-II) for the surveillance and treatment monitoring of hepatocellular carcinoma (HCC). The experts agreed that PIVKA-II could be valuable in the detection of HCC in AFP-negative patients and for monitoring curative and intra-arterial locoregional treatments, outcomes, and recurrence. However, more evidence is required for the combined use of PIVKA-II with ultrasound and AFP for HCC surveillance, including small HCC. Implementing PIVKA-II in the region will also have challenges, such as standardizing cut-off values, cost-effectiveness, and improving awareness among healthcare providers.