OBJECTIVES: The optimal treatment choice for preserving quality of life (QoL) of the about 64,000 men diagnosed with prostate cancer each year in Germany still remains unclear. The objectives therefore were to estimate cost utility under day-to-day conditions of caring for men in Germany with newly diagnosed LCLRPC using hormonal therapy (HT), active surveillance (AS), radiotherapy (RT), operation (OP), or watchful waiting (WW) – HAROW. METHODS: The long-term observational multi-centre HAROW study combined data collection from urologists (clinical data; utilized outpatient medical services, OMS) and from patients (employment status, QoL by EQ-5D, numerous health resource use items). Resource use was valued by year 2010 official prices in €. Direct costs (DC) were given by hospital treatment, OMS and drugs, inpatient rehabilitation, patients’ co-payments. Indirect costs (IC: sick leave, premature retirement, premature mortality) were estimated by 2010 gross domestic product/capita/day. Costs and quality-adjusted life-years (QALYs) were discounted by 3% per annum. Strategies with significantly different QALYs/patient-year (PY) were compared by CUA, remaining strategies by cost-minimization analysis. RESULTS: From 07/2008 to 03/2013, 3063 LCLRPC patients (T1a–T2c, N0, M0; 67.3±7.5 years) were included from 257 urologists: AS n=452, RT n=378, HT n=210, HT+RT n=80, combination therapy (CT) n=137, OP n=1647, other therapy (OT) n=18, WW n=141. Observation period: average 1.9 years, maximum 4.6 years. From the societal perspective (DC+IC), AS and RT each dominated HT, i.e. there were savings/PY (€257 and €208) and QALYs gained/PY (0.0811 and 0.0587) with AS and RT, respectively, versus HT. When comparing OP to HT, there were additional cost (DC+IC) of €5134/PY and 0.0784 QALYs gained/PY for OP versus HT leading to €65,525 per QALY gained. CONCLUSIONS: The HAROW study provides meaningful results on cost utility of AS, OP, RT, and HT as LCLRPC treatment strategies under day-to-day conditions of care in Germany to support decision making.