Background: Prostate cancer is one of the most common adult malignancies. Two well characterized risk factors for prostate cancer (PCa) are family history (FH) and race. The goal of this study was to distinguish the influence of family history and race with regards to clinically relevant covariates. Methods: In this single-institution study, 497 PCa patients from Tulane Hospital were clinically annotated and FH was evaluated. FH was defined as having ≥ 1 first degree relative affected with PCa and/or ≥ 2 affected second or third degree relatives. There were 147 AA and 350 CA patients; 66 AA and 120 CA reported PCa FH. The following clinical factors were documented: age and PSA at diagnosis (dx), Gleason score (biopsy or radical prostatectomy), and presence of metastasis (at any time). Chi-square, ANOVA, and odds ratio tests were performed to identify potential clinical correlates with regard to FH and race. Results: Results indicate that race and FH are not independent (p = 0.0266), where AAs were 1.5 times more likely to have a FH of PCa than CAs (95% CI 1.0543-2.3133). On average, men with a FH of PCa were younger at dx (p = 0.0063). FH significantly impacted age at dx for AAs (p = 0.036) but not CAs. No difference in age of dx was detected between race. FH of PCa did not influence PSA at dx in either CA (6.5, 1.2-681) or AA (19.2, 1.7-500) men, however race did (p = 0.004). CAs with FH of PCa were more likely to be diagnosed with low or intermediate risk PCa (Gleason score ≤ 7, p = 0.03). Gleason scores were not significantly different between races. Overall, FH did not influence metastasis. Although, AAs (n = 19) were 1.61 times more likely to develop metastatic disease compared to CA men. Conclusions: For AAs, FH lowered age at dx but did not have influence on development of metastatic disease, Gleason score or PSA. For CAs, Gleason score was lower in men with a FH. Overall AAs, as compared to CAs had more metastatic disease and higher PSAs at dx. Continuing to track clinical differences between AAs and CAs with a FH of PCa may provide additional insights into underlying racial and clinical disparities.