Objective The purpose of this study was to examine the proportion of men who died from prostate cancer (PrCa) vs. with PrCa and assess the comorbid conditions associated with other-cause deaths. Study design and setting We identified all male decedents aged ≥65 years in Jefferson County, AL, in 1993-1995. By crosslinking three databases (death certificate, Medicare, and Veteran's Administration), we identified men whose deaths might have been caused by PrCa. We abstracted and reviewed medical records to rate comorbid conditions and determine whether or not death was due to PrCa. Results Of 561 men with a premortem diagnosis of PrCa, 42% died from PrCa and 53% died with PrCA; 50.2% of blacks died from PrCa vs. 36.9% of Whites. Other factors related to dying with PrCa included older age at death and a serious, or very serious, comorbid condition. Treatment did not have an independent effect on cause of death (i.e., death with vs. from PrCa). Conclusions Comorbidity was an independent predictor of dying with PrCa, even after adjustment for ethnicity, age, and treatment. Given the as yet unproven benefit of PrCa screening, our results extend the body of information relevant to the screening decision; among men dying with a diagnosis of PrCa, only about 1/3 to 1/2 died from the disease. © 2004 Elsevier Inc. All rights reserved.