According to a commentary, the findings from both PROSPER and SPARTAN show that the greatest decrease in quality of life among men receiving treatment for prostate cancer probably occurs from initial therapies (androgen deprivation therapy, radical prostatectomy, and radiotherapy), and that the addition of second-generation androgen deprivation therapy does not seem to add substantially to the decrease in quality of life observed with conventional first-line androgen deprivation therapy. It concludes that given the significant improvement in distant metastasis-free survival shown in both PROSPER and SPARTAN and the minimal effect on quality of life, the threshold for use of second-generation androgen deprivation therapy should be low.