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This study was conducted to explore whether racial/ethnic differences exist in treatment discussed, preferred, and ultimately received for localized prostate cancer (PCa) as epidemiological data are scant on this issue. The authors recruited 640 localized PCa patients from the Texas Medical Center, Houston, Texas, between 1996 and 2004. The authors used a structured questionnaire to collect data through personal interviews. Three main treatment modalities for localized PCa, consisting of surgery, radiation therapy, and watchful waiting, were considered for this study. It was found that health professionals were less likely to discuss surgery (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.18-0.68) and watchful waiting (OR = 0.53, 95% CI = 0.34-0.83) with Hispanics than Whites. However, African Americans were less likely to receive watchful waiting (OR = 0.22, 95% CI = 0.05-0.93). They were more likely to prefer (OR = 1.23, 95% CI = 0.78-1.94) and receive (OR = 1.27, 95% CI = 0.87-1.86) radiation therapy, although they did not achieve statistical significance ( p < .05). Higher age was associated with lower likelihood of discussing, preferring, and receiving surgical treatment. Higher Gleason sum was associated with lower likelihood of discussing treatment. A comparison of concordances between treatment preferred by patients and what was actually received, in general, showed a higher agreement for surgery and radiation therapy. More exploration needs to be done in other settings to confirm these findings.