OBJECTIVES: The optimal treatment choice for preserving QoL of the about 64,000 men diagnosed with prostate cancer each year in Germany still remains unclear. The objectives therefore were to generate long-term information under day-to-day conditions on QoL of men in Germany cared for 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 was undertaken. The urologist provided all relevant clinical data of the patient. The patient provided inter alia data on QoL using the EQ-5D. Utilities derived from the EQ-5D based on the German value set were used to construct quality-adjusted life-years (QALYs). QALYs were discounted by 3% annually and standardised to mean QALYs per patient-year (PY) for each initial treatment strategy. Differences between strategies were tested using the Kruskal-Wallis test (Bonferroni-corrected p=0.0018 due to 28 tests). RESULTS: Between July 2008 and March 2013, 3063 patients (mean age 67.3 ± 7.5 years) with LCLRPC (T1a–T2c, N0, M0) were included from 257 urologists. Data on QoL were documented by patients as follows (% of patients/strategy): AS n=353 (78%), RT n=291 (77%), HT n=149 (71%), HT+RT n=68 (85%), combination therapy (CT) n=109 (80%), OP n=1167 (71%), other therapy (OT) n=9 (50%), WW n=93 (66%), over a mean time of between 1.6 (OT) and 2.5 years (CT). AS showed the highest undiscounted/discounted QALYs/PY (0.9297/0.9103) followed by OP (0.9289/0.9075), RT (0.9075/0.8878), CT (0.9071/0.8820), OT (0.8954/0.8818), HT+RT (0.8875/0.8699), WW (0.8646/0.8465), and HT (0.8485/0.8292). Compared to HT, QALYs/PY were significantly higher with AS (p<0.0001), with OP (p<0.0001), and with RT (p=0.0002). Tests with undiscounted/discounted QALYs/PY adjusted for age, tumor stage and comorbidity showed no different results. CONCLUSIONS: According to the HAROW study, active surveillance yielded the highest QALYs of the different LCLRPC treatment strategies in Germany evaluated.