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INTRODUCTION AND OBJECTIVE: The purported increased risk of early, aggressive disease has led to the classification of men of African descent as high risk with subsequent recommendations of more aggressive screening practices in these men. However, the underlying data for these recommendations lack high quality evidence, leaving the validity of these conclusions uncertain. Canadian healthcare data is uniquely suited to study the impact of ethnicity on prostate cancer mortality due to its diverse population and universal healthcare. METHODS: This retrospective cohort study uses Statistics Canada?s Canadian Census Health and Environment Cohort linking the mandatory 1991 long form census with healthcare, tax, and mortality databases to investigate the role of ethnicity on prostate cancer mortality. All men diagnosed with prostate cancer between 1992 and 2010 were included. Cox proportional-hazards models were used to predict the association between ethnicity and mortality accounting for immigrant status, age, and education. RESULTS: 51,530 cases of prostate cancer diagnosed between 1992 and 2010 (table 1). 29,705 of these men died with 7,925 of these deaths caused by prostate cancer. Non-minority men had higher or equivalent rates of prostate cancer-specific mortality compared to all visible minority groups (table 2). South Asian (HR 0.53 95% CI 0.36-0.76) and East Asian men (HR 0.62 95% CI 0.49-0.79) were seen to be at lower risk compared to non-visible minorities while Black men showed no increased risk (HR 0.83 95% CI 0.67-1.02). CONCLUSIONS: South and East Asian men were found to have lower risks of prostate cancer-specific mortality while there was no increased risk seen in black men. Black men have traditionally been classified as a high-risk prostate cancer population. However, it is unclear whether these risks are truly due to the cancer or whether there are social and societal barriers confounding the poor outcomes. Our study highlights the importance of addressing socioeconomic and cultural barriers to healthcare and the need for caution when drawing conclusions from observational studies.