In a recent study, patients experienced significant impairment of sexual and vitality/hormonal quality of life (QOL) within the first 2 months of receiving neoadjuvant androgen deprivation therapy (ADT), even before starting definitive radiotherapy. 450 men completed the Expanded Prostate Cancer Index Composite-26 questionnaire before and shortly after starting neoadjuvant ADT, 71 of whom received ADT prior to radiotherapy. The significant QOL effects of this therapy should be weighed carefully against potential clinical benefit.