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Prostate cancer accounts for the largest group of cancer survivors in men. Hormone therapy is essential, especially in advanced disease. While its short-term effects are well studied, research into the long-term effects on health-related quality of life (HRQOL) remains limited. Therefore, this review aims to synthesize and identify key gaps in the literature on HRQOL and symptom burden in long-term prostate cancer survivors who underwent hormone therapy. After searching four databases until 15 April 2025, we identified 14 observational studies that reported on general and prostate cancer-specific HRQOL in prostate cancer survivors ≥ 5 years post-diagnosis. Survivors who underwent hormone therapy reported worse global health status and physical, emotional, and social functioning compared to those treated with local therapies like prostatectomy or radiation. These survivors also experienced greater symptom burdens, alongside worse vitality and mental health. Prostate cancer-specific issues, such as bowel and urinary bother and sexual dysfunction, were also more pronounced in hormone therapy recipients. Nevertheless, outcomes beyond 15 years remain under-researched. The findings of this review highlight the importance of discussing long-term HRQOL compromises with patients who consider hormone therapy. However, they warrant cautious interpretation, particularly due to limited details on hormone therapy regimens and inadequate control for stage.