INTRODUCTION and OBJECTIVES: Treatment for prostate cancer has significant impact on health-related quality of life (HRQOL). We examine HRQOL in a cohort of men who opted for surveillance as initial treatment followed by androgen deprivation therapy (ADT) and compare them with other treatments. METHODS: CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) is a national observational database of men with prostate cancer. We identified a cohort of newly diagnosed men with prostate cancer who completed two or more instruments that measure generic and disease-specific HRQOL. Individuals were grouped by initial treatment: ADT, surveillance, radical prostatectomy, and radiation therapy. RESULTS: Initial treatment was as follows: ADT (n=167), surveillance (n=106), radical prostatectomy (n=351), radiation therapy (n=75). Sixty-seven men selected surveillance followed by ADT. Mean age at diagnosis was 73 years with surveillance patients being older. Men significantly poorer urinary (decline of 7 points on a 100 point scale) and sexual function (decrease of 10 points) compared with surveillance. HRQOL for ADT, surveillance and radiation therapy patients changed little over the year following treatment, while men undergoing radical prostatectomy showed improvement in all aspects of HRQOL. Scales are scored from 0-100 with 100=better function and a difference of 7-10 points is considered clinically significant. CONCLUSIONS: Patients receiving ADT had reduced energy, poorer sexual and urinary function and were more bothered by their urine function than patients undergoing other treatments. Longer follow-up after start of ADT and surveillance is needed to discern the impact of other factors, including comorbidities.