<p>Shared decision-making (SDM) plays an important role in patients with prostate cancer due to the complexities of screening and treatment. This study assessed the racial and ethnic disparities in SDM in patients diagnosed with prostate cancer in the United States. This cross-sectional analysis utilized 2014–2021 Medical Expenditure Panel Survey (MEPS) data. Male patients ≥ 18&#xa0;years old with a diagnosis of prostate cancer were included. The Consumer Assessment of Healthcare Providers and Systems survey was used to operationalize the SDM, with scores categorized as poor (4–8), average (9–11), and optimal SDM (12). Multinomial regression model was used to analyze the racial and ethnic disparities in SDM among prostate cancer patients after adjusting for other covariates guided by the Andersen Behavioral Model. We identified 1.39 million (95%CI: 1.3–1.49) patients with prostate cancer between 2014 and 2021. The predominant race was White (64.4%), followed by African American (20.65%) and Hispanic (10.60%). Overall, 41.56% of patients reported optimal SDM scores, 49.82% reported average, and 8.62% reported poor SDM scores. The multinomial model revealed that the Hispanic patients had significantly higher odds of poor SDM scores than White patients (adjusted odds ratio:3.23, 95% CI: 1.14–9.46). Compared to optimal SDM, African American and White patients showed no significant differences in the odds of reporting poor or average SDM (<i>p</i> = 0.14 and <i>p</i> = 0.09, respectively). This study found that one in ten patients reported poor SDM for prostate cancer, with a higher likelihood of poor SDM among Hispanics. Concerted efforts are needed to improve the cultural competency and communication skills aimed at Hispanic patients to improve patient-centered care.</p>