OBJECTIVES: Little information is available about physician visit and referral patterns among patients diagnosed with Stage IV PCa. The objective of this study is to characterize patient referrals between urologists and medical oncologists/hematologists (MOH) following diagnosis of Stage IV disease. METHODS: A retrospective analysis of linked Surveillance, Epidemiology, and Endpoints (SEER) - Medicare data included patients diagnosed with Stage IV PCa between 1994 and 2002 (age > 65 years). Patients who saw a MOH before the urologist visit were deleted. Patients were grouped according to M0/M1 substage. Time to physician visit, in months (m), was defined relative to diagnosis in the base case. RESULTS: Application of the inclusion and exclusion criteria resulted in 8840 patients (average age 77 years; 81% White; 68% M1 disease). Seventy-four percent of the patients visited a urologist. Of these, 33% followed up with a MOH. Of these, 41.5% saw the MOH within 6m, 55.7% within 12m, and 25% waited >24m. The mean time to MOH visit was longer when a patient saw a urologist first, compared to when a patient did not see a urologist (20.1m vs. 5.2m; p<0.0001). M1 patients saw MOH sooner than M0 patients: 14.1m vs. 27.5m; p<0.0001. Qualitative results were similar whether conditioned for a urologist visit (16.9m vs. 29m; p<0.0001) or conditioned for ‘no urologist visit' (4.6m vs. 11.1m; p<0.01). CONCLUSIONS: Similar to other studies, we find that the majority of patients with Stage IV PCa see a urologist post diagnosis. About a third of patients who see a urologist are referred to a MOH and 25% wait more than 2 years to see the MOH. We find that the time to a MOH visit averages 20 months among those who first see a urologist versus 5 months among those who do not.