OBJECTIVES: To examine the economic burden and health care utilizations of prostate cancer patients in the U.S. veteran population. METHODS: Patients diagnosed with prostate cancer (ICD-9: 185.xx) were identified from the U.S. Veterans Health Administration (VHA) Medical SAS dataset from October 01, 2009 through September 30, 2011. The first diagnosis date was defined as the index date. A comparator group was created by identifying patients without prostate cancer but with the same age, region, gender, index year, and matched baseline Charlson Comorbidity Index. The index date for the comparator group was randomly chosen to reduce selection bias. A 1-year continuous health plan enrollment was required before and after the index date for both groups. Study outcomes, including health care costs and utilizations, were compared between the disease and comparator groups using 1:1 propensity score matching (PSM). RESULTS: Eligible patients (N=384,596) were identified for the prostate cancer and comparison cohorts and after applying PSM, a total of 112,693 patients were matched from each group and the baseline characteristics were well-balanced. Patients diagnosed with prostate cancer were more likely to be hospitalized (75.41% vs. 2.46%, p<0.01), and report more emergency room (9.30% vs. 5.45%, p<0.01), outpatient (99.77% vs. 61.15%, p<0.01) and pharmacy visits (85.65% vs. 63.77%, p<0.01). Patients diagnosed with prostate cancer also incurred higher costs for inpatient ($2,216 vs. $695, p<0.01), emergency room ($92 vs. $51, p<0.01), outpatient ($3,364 vs. $1,462, p<0.01), pharmacy ($582 vs. $413, p<0.01) and total costs (6,162 vs. $2,571, p<0.01) compared to the comparator group.  CONCLUSIONS: Patients diagnosed with prostate cancer were associated with a higher burden of illness compared to their matched controls during a period of 12 months.