The physical burden of prostate cancer is considerable and affects quality of life in men with both localized and metastatic disease. This physical impact results as much from treatment for prostate cancer as from the disease itself. In advanced disease, although patients can experience considerable pain and discomfort from bony lesions, they also can experience bothersome fatigue and sleep disturbances from institution of hormone ablation therapy. In localized disease, although patients can have lower urinary tract symptoms from untreated prostate cancer, all aggressive treatments can result in urinary, sexual, and bowel dysfunction that can bother the patient and affect quality of life. Patients and providers must be vigilantly aware of the physical burden of prostate cancer when initiating treatment for this disease and during follow up after treatment. By being cognizant of the physical impact of prostate cancer on quality of life, providers can address patients' problems early in their course of treatment and maximize patients' HRQOL and overall satisfaction with care.