OBJECTIVES: Increasing attention has been paid to team-based approaches to the management of patients with advanced prostate cancer (PCa). It is not known whether the timing of specialist contacts relative to treatment initiation is associated with survival. This study examines whether patients with visits to a medical oncologist/hematologist (MOH) before treatment have better survival outcomes than those who see a MOH after treatment begins. 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) who received treatment and a referral. Treatment was defined as the receipt of orchiectomy, hormone therapy, chemotherapy, or radiation at any time following diagnosis. A referral was defined as a post-diagnosis visit to an urologist followed by a visit to a MOH. The key covariate identified patients referred prior to treatment initiation. Colon cancer – specific mortality models controlled for potential confounders including demographic, clinical, continuity-of-care, and ecological measures. RESULTS: A total of 2075 patients with Stage IV PCa met the inclusion criteria. The average age in the sample was 75 years and 83% were White. Seven percent of patients visited both specialists before receiving treatment. Referral visits prior to the start of treatment were associated with a reduction in the relative risk of disease – specific mortality (HR: 0.7; 0.5 – 0.9, p=0.02) in the full sample and in a propensity-matched sample (HR: 0.6; 0.4 – 0.9, p=0.006). CONCLUSIONS: As treatment options for advanced stage PCa evolve, patients may benefit from contact with a team of specialists. We find that there is a survival benefit associated with referrals that occur prior to treatment initiation. The results suggest that the timing of specialist visits is important for PCa survival. Further studies on referral patterns are needed to validate these results.