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Quality-of-life outcomes are an important consideration for patients evaluating therapeutic options for localized prostate cancer.The objective of this study was to describe the effect of treatment choice on change in health-related quality of life (HRQOL) among men with clinically localized prostate cancer.This was a prospective observational study.The study subjects were 122 men with clinically localized adenocarcinoma of the prostate. Forty-two subjects (34%) underwent radical prostatectomy, 51 (42%) underwent radiation therapy, and 29 (24%) were followed with e-pectant management.The University of California at Los Angeles Prostate Cancer Quality of Life Inde- and the Medical Outcomes Study Short Form-36 were administered before and 3 and 12 months after initial treatment. The study used an analysis of covariance model adjusted for baseline differences in clinical and demographic factors.Men who underwent radical prostatectomy e-perienced significant declines in urinary and se-ual function and bother that persisted at 12 months after treatment. Men treated with radiation therapy e-perienced smaller but significant declines in se-ual function and a decline in social function. E-pectant management patients did not have a significant change in disease-targeted or generic HRQOL domains. Differential rates of change in urinary and se-ual function between treatment groups persisted after adjustment for differences in pretreatment clinical and demographic factors.Men undergoing radical prostatectomy have substantial declines in urinary and se-ual function, and men undergoing radiotherapy have declines in se-ual function. Men undergoing e-pectant management have no change in disease-specific or general HRQOL in the first year after treatment.