*Purpose: Recent recommendations from expert panel of American Society of Transplantation (AST) state that most patients with prostate cancer (PCa) do not need to wait additional time, due to PCa, for kidney transplant (KT) even though there is limited data on how post transplant outcomes compare to dialysis patients with PCa.

*Methods: Utilizing Surveillance Epidemiology End Results (SEER)-Medicare registry data, we retrospectively studied ESKD (dialysis and kidney transplant) patients (≥40 years old), who were diagnosed with prostate cancer between January 1, 2004 and September 30, 2015 after established ESKD diagnosis. Distribution of stage at diagnosis was compared between dialysis and KT using chi-square test. Time to all-cause death (OM) and time to death due to PCa (CS), by stage at diagnosis were compared using Kaplan-Meier, Cumulative Incidence Function, Cox-proportional hazards and Fine-Gray competing risk models.

*Results: A total of 1959 patients met our eligibility criteria (1478 on dialysis and 481 with functioning KT). KT patients were more likely to present with local stage and less likely to present with distant stage at diagnosis than dialysis counterparts

In the multivariable models, KT had 45% lower hazard of OM (_0.460.55_0.66) and no difference in CS (_0.420.68_1.11). Patient characteristics that were associated with worse CS included regional and distant stage at presentation, Gleason score >8, and PSA level > 20

Interestingly, receiving surgery or radiation was not associated with improvement in CS (_0.670.95_1.36).

*Conclusions: Our study shows that, compared to dialysis patients, kidney transplant recipients with prostate cancer have almost two times better overall survival but similar prostate cancer specific survival. Moreover, receiving surgery or radiation for prostate cancer is not associated with improved prostate cancer specific survival. These findings support the recent recommendation made by AST expert panel that for kidney transplant candidates with prostate cancer, no waiting prior to transplant or treatment for prostate cancer is necessary for localized and regional stages.

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