OBJECTIVE: This study aimed to 1) assess and compare the preferences and utilities for prostate cancer (PC) health states from men at increased risk for disease to published reports of healthy men, men with PC, and physician preferences/utilities, and 2)evaluate the theoretical congruence of utility values solicited from an at-risk population with the conceptual framework for utility elicitation, Welfare Economics. Several cost-utility studies have shown little benefit for the cost of screening or treatment of asymptomatic PC. However, subjects from whom utilities were elicited in these studies were not those who would be most affected by health policy decisions. Further, several reports assessed utilities from subjects who violate certain tenets (e.g., Veil of Ignorance) of Welfare Economics. METHODS: 81 men without PC but at increased risk for disease (defined by age, ethnicity and family history), participating in a PC Risk Assessment Program, were interviewed using the Time Trade-Off Technique. Men's preferences and utilities for health states of impotence and incontinence associated with treatment options of PC were assessed. RESULTS: Utility values ranged from a high of 0.8859 (SD 0.2317) for a small (10%) risk of incontinence associated with radiotherapy to a low of 0.7571 (SD 0.2802) for a high (99%) risk of impotence associated with hormones. As compared to previous reports of healthy men and physicians, men at-risk for PC in this study had a higher utility for therapies that have a higher probability of preserving quality of life, but not as high as men diagnosed with PC. CONCLUSION: Men at-risk for PC had utilities values for health states associated with treatment options intermediate between healthy men and men with cancer, supporting our hypothesis. We discuss why populations at-risk may theoretically be more congruent with Welfare Economics and the Veil of Ignorance concept than populations previously reported in the literature.