This Practice Point commentary discusses the study by Lu-Yao et al. in which primary androgen deprivation therapy (PADT) was compared with conservative treatment in elderly men with localized prostate cancer. Overall, PADT was associated with worse cancer-specific survival than conservative management; however, in the subgroup of patients with poorly differentiated cancer, PADT was associated with improved cancer-specific survival. Although the authors defined conservative treatment as no definitive treatment during the 180 days after diagnosis, many patients in the conservative treatment group would have subsequently received definite treatments, including surgery or radiation therapy. The results of this study, therefore, do not necessarily demonstrate inferiority of PADT to conservative treatment. Accurate evaluation of the efficacy of PADT is confounded by a number of factors, such as the type of androgen deprivation therapy used. Efforts should be made to reduce the adverse effects of androgen deprivation therapy because a high proportion of patients actively choose this treatment modality as primary therapy.