OBJECTIVES: Men's motivation to attend a Prostate Cancer Risk Assessment Program (PRAP) is under study. Previous PRAP work shows motivation to be unrelated to risk-knowledge and perceptions. This study assesses differences in quality of life profiles between two cohorts; men "at-risk" for prostate cancer (PC); and "normal" men without known risk of PC. METHODS: Functional Assessment Cancer Therapy (FACT) sub-scale scores were compared between cohorts; 331 men participating in PRAP in the NE United States and 456 men with complete FACT data, from an internet-based survey sample (1400 men randomly drawn from a demographically balanced sample of the United States population) recruited through Knowledge Networks, Menlo Park, CA. RESULTS: Three hundred seventy-six (82%) of "normal" men vs. 142 (43%) of "at-risk" men were Caucasian. Mean [median] age was 48.1 [46] for "at-risk" and 43.5 [42] years for "normal" men. Age and ethnicity were controlled in subsequent analyses. The "at-risk" group demonstrated higher physical and functional well-being (PWB/FWB) scores than the "normal" group (p<0.0001). Analyses showed that the effect of PC risk on emotional well-being (EWB) depended on subject's age (p<0.027). When separated into 2 groups depending on the overall median age, both younger (<44 years) and older (>45 years) "normal" men showed significantly higher EWB scores than "at-risk" men; the difference being more pronounced among younger men. EWB score did not depend on the race of the subjects. CONCLUSION: The results indicate that although the men "at-risk" were older, they report being more physically fit than the younger "normal" group but had poorer EWB. Since risk knowledge and perceptions have been poor predictors of motivation to screen, it may be that motivation is associated with an emotional "gestalt" related to risk and a desire to stay fit to overcome risk.