Background: Maximizing health-related quality of life (HRQOL) is an important therapeutic goal for metastatic prostate cancer patients. Moreover, HRQOL measures can inform clinicians about treatment sequelae and aide decision-making. To date, few studies have comprehensively compared HRQOL between metastatic prostate cancer survivors and survivors with localized diseases and men without a cancer history. Methods: The SEER-Medicare Health Outcomes Survey (MHOS) data linkage was used to identify prostate cancer survivors and individuals without a cancer history enrolled in Medicare Advantage plans. Prostate cancer survivors (diagnosed 1988-2017) who completed the MHOS baseline survey (1998-2019) after diagnosis but < 10 years post diagnosis were included, as were men without a cancer history who completed the MHOS in the same years. Survey records were clustered at person-level. 27,829 prostate cancer survivors with 42,277 survey records (metastatic n = 752 with 1040 records) and 784,305 Medicare Advantage enrollees in SEER regions without a cancer history with 1.15 million survey records were identified. Multilevel linear regressions were used to compare HRQOL outcomes, i.e. The Veterans RAND 12 Item Health Survey (VR-12 scores), between metastatic survivors and other survivors, and men without a cancer history. The VR-12 includes 8 health domains: general health, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health. All analyses adjusted for age at survey, stage, comorbid conditions, body mass index, race/ethnicity, marital status, socioeconomic status, SEER region, and survey era. Results: Compared to men without a cancer history, prostate cancer survivors were older, had fewer comorbid conditions, were more likely to racial/ethnic minorities, married, and higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors were most likely to report worse general health (T-score difference: -6.26, 95% confidence internal [95CI]: -7.14 to -5.38; p <.001), and physical (T-score difference: -4.33, 95CI: -5.18 to -3.48; p <.001) and mental component summary (T-score difference: -2.64, 95CI: -3.40 to -1.88; p <.001), followed by survivors with early stage diseases in adjusted analyses. Results were similar for other HRQOL VR-12 measures. Conclusions: Metastatic prostate cancer survivors experience significantly worse HRQOL than men diagnosed with early-stage disease and men without a cancer history across all domains. Our findings suggest a need for better symptom management and palliative care for men diagnosed with metastatic prostate cancer.