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Introduction: Though the prevalence of metastatic prostate cancer is decreasing, the rate of admission from the emergency department (ED) is increasing. Little is known about the implications of metastatic site on a patient's ED course and admission., Materials and Methods: A weighted estimate of 15,367 patients with metastatic prostate cancer who presented to the ED between January 1, 2006 and December 31, 2009 was abstracted from the Nationwide Emergency Department Sample (NEDS). Descriptive statistics were used to elaborate patient and hospital characteristics of the metastatic prostate cancer population and logistic regression models were fitted to identify predictors of admission., Results: The most common site of metastasis in patients with metastatic prostate cancer presenting to the ED was bone (80.6%), followed by liver (13.2%), lung (9.3) and other genitourinary sites (8.1%). Over the study period, there was an increase in prevalence of the four commonest metastatic sites, and admission rates varied between metastatic sites (83.2% for bone to 95.2% for nodal metastasis). Substantial variability in the rate of inpatient mortality was noted. Increasing age, Northeast region, increased comorbidity burden, and the presence of nodal metastases and other urinary metastases were shown to be independent predictors of hospital admission., Conclusions: The commonest metastatic site in patients presenting to United States EDs with metastatic prostate cancer between 2006 and 2009 was bone. Patients presenting with nodal metastases were most likely to be admitted. Independent predictors of hospitalization included age, Northeast region, increased comorbidities, nodal metastases and other urinary metastases.