Purpose: Guidelines state that PCa screening be done only after patients are fully informed. African American (AA) men are diagnosed with prostate cancer (PCa) at higher rates than whites and their prognosis is worse. However, it is not known if men are aware of their risk or are prepared to make impending treatment decisions at the time of biopsy. Method: Patients were surveyed at their appointment for a prostate needle biopsy. The surveys contain items on socio-demographics, general anxiety on the Hospital Anxiety and Depression Scale (HADS), PCa-specific anxiety on the Memorial Anxiety for Prostate Cancer (MAX-PC), as well as their estimated likelihood of having PCa and anticipated treatment choices. Medical records provided biopsy results and telephone follow-ups with patients with positive biopsies determined actual treatment choices. Results: Analyses of men (N = 243; 63±7.9 years old; 39% African-American; 56% college degree or higher) showed both an ethnic difference in their estimated probability of having PCa and an overall inaccuracy in predicting results and treatments. Over one third of men indicated they had a 0% chance of having PC, including over 55% of AA. In regression analysis on the outcome of self-rated probability of PCa, AA patients rate their probability lower than whites (β = -0.21, p<.01). Patients with higher disease-specific anxiety on MAX-PC rated their probability higher (β = 0.22, p<.02). Biopsy results were available on 172 patients and over 50% of them (70% of AAs and 44% of whites) had PCa. After controlling for covariates, patient ratings of PCa likelihood did not predict test biopsy result, but older age, higher pre-biopsy PSA score, and lower self-rated health were significant predictors. Additionally, these patients did not predict above chance what treatment they ultimately chose. Conclusion: Patients' underestimate of their probability of having PCa, especially AA patients who actually have a higher risk. Patients' estimations of their probability of having PCa relate to PCa-specific anxiety but not to general anxiety, suggesting that it is not “worriers” who believe they have PCa but instead those who are specifically worried about the disease. The fact that PCa anxiety is not predictive of having PCa suggests the wrong patients are most worried. Furthermore, those with PCa are not able to self-predict future treatment choice.