OBJECTIVES: To compare rates of subsequently diagnosed mental health issues (MHI), and time to develop any MHI in men with localized prostate cancer who underwent conservative management (CM) or cryotherapy. METHODS: The Surveillance, Epidemiology and End Results (SEER)-Medicare linked data from 2000-2013 was used. Patients’ aged 65 years or older with stage I and stage II cancer diagnosis and no prior MHI were included. Patients in the CM cohort were identified as those who did not receive any immediate treatment within 6 months of diagnosis of localized prostate cancer. Patients in the cryotherapy cohort were identified using ICD-9 procedure code, Healthcare Common Procedure Coding System (HCPCS) code/Current Procedural Terminology (CPT) code. The diagnoses of any MHI (major depressive disorder, anxiety, depression-not otherwise specified (NOS), neurotic depression, and adjustment disorder with depressed mood) were identified using the ICD-9 codes. Rates of each of the MHI were assessed. A cox proportional hazard model was used to estimate time to develop MHI in the cohorts. All analyses were performed using SAS (version 9.4). RESULTS: There were 13,161 and 3,533 patients in the CM and cryotherapy cohort, respectively. Rates of MHI were lower in the CM compared to cryotherapy cohort: neurotic depression (0.25% and 0.42%, respectively); major depressive disorder (0.49% and 0.58%, respectively); anxiety disorders (2.38% and 2.69%, respectively), adjustment disorder with depressed mood (0.17% and 0.25%, respectively), and depression NOS (2.05% and 2.41%, respectively). Median time to develop any MHI in the CM and cryotherapy cohort were 62.9 months and 54 months, respectively, and the risk of being diagnosed was 16.5% higher in the cryotherapy cohort (hazard ratio [HR] = 1.17 [1.02 – 1.41]). CONCLUSIONS: Findings suggest that the burden of MHI is greater with cryotherapy treatment in comparison to CM. Patients who receive cryotherapy may need additional mental health monitoring and treatment to avoid negative outcomes.