OBJECTIVE: This pilot study compared the preferences and utilities for impotence and incontinence associated with prostate cancer (PC) treatments between men with PC and their wives. Several studies have shown little congruence between stated and observed preferences. We hypothesize that spousal influence may be a significant predictor of observed, versus stated, preferences. METHODS: Seven husband/wife dyads were recruited from radiotherapy and urology follow-up clinics. Each spouse was interviewed without the other present, using the Time Trade-Off Technique. RESULTS: The husband-wife dyads demonstrated disparate preferences 50% of the time. Whereas 43% and 71% of husbands stated they would be willing to give up > 6 mos of a 7-year survival to avoid a 40% and 80% risk of impotence, respectively, only 14% of wives would be willing for their husbands to give up to 6 mos of life to preserve potency at any level of risk. For incontinence 14% and 29% of husbands vs. 0 and 14% of wives stated they would be willing to give up, or have their husband give up, > 6 mos of a 7-year survival to avoid a 10% and 30% risk of incontinence, respectively. When surgery, radiotherapy and watchful waiting (WW) were presented with the same life expectancy but a 99% risk of impotence with the first two options and potency with the latter, 57% of husbands vs 14% of wives chose WW. When the same treatment options were presented with the same life expectancy but a 99% risk of incontinence with the first 2 options and urinary continence with the latter, 71% of husbands vs 14% of wives chose WW. CONCLUSION: Wives had a higher utility than husbands for any treatment option vs. WW, that prolongs the husbands life regardless of level of risk of quality of life decrements. Wives' preferences were more congruent with observed (vs. stated) preferences of the husbands.