Globally, the incidence and prevalence of prostate cancer are increasing, with more than 1·2 million men now estimated to be diagnosed every year. 1 Although in countries such as the USA and Australia, most men will be diagnosed with localised disease, 2 the burden of metastatic disease is still substantial and unevenly distributed. 3 Furthermore, men with advanced or metastatic disease experience poorer quality of life, and higher psychological morbidity and risk of suicide than men with localised disease. 4 , 5 Therefore, for these men, a consideration of the patient experience is crucial. In The Lancet Oncology, Neeraj Agarwal and colleagues 6 present patient-reported outcomes from the TITAN study, providing insight into the effects on quality of life when apalutamide is used as an adjunctive therapy to androgen deprivation in men with metastatic castration-sensitive prostate cancer. The question of treatment burden is important to men diagnosed with metastatic castration-sensitive prostate cancer, for whom overall survival, as well as radiographic progression-free survival and delay to cytotoxic therapy, are critical. But do treatments that improve these outcomes come at a cost of compromised quality of life?