Background: Men diagnosed with prostate cancer (PCa) have a 5-year overall survival (OS) rate of 98%. However, this rate plummets to approximately 30% for men diagnosed with metastatic PCa. Furthermore, PCa exerts a greater burden on African American men with a higher incidence and a higher mortality rate than other races. These disparities have been contributed to a result of interactions among genes, health behaviors, and access to care. In our study, we examined Social Determinants of Health (SDoH) – social risk factors that contribute to disparities in cancer mortality. Area deprivation index (ADI) is one of the assessments used to measure these social risk factors. ADI can assess a geographic area’s level of socioeconomic deprivation and is associated with health outcomes on the census block level. Variables used in ADI are grouped into 4 domains – education, income, employment, and housing quality. Most of the communities will fall between a standardized score of 40 to 160. In this study, we used a large population-based cancer database to examine the impact of ADI on risk of metastatic PCa at diagnosis in Ohio. Methods: The Ohio Cancer Incidence Surveillance System (OCISS) data were examined for the period 1996 to 2016 to predict the odds of distant stage at diagnosis. Generalized additive models were constructed with age and year of cancer diagnosis, area deprivation index, race, and Hispanic ethnicity as predictors. The relationship between continuous variables and odds of distant diagnosis was modeled via penalized cubic splines. Odds ratios were calculated for race and Hispanic ethnicity. To summarize the results for variables modeled via splines, predicted probabilities were calculated with other variables held at their average or reference values. Results: We identified 112,023 men with PCa in OCISS database. The median age was 67 (IQR 61-67) years old. Subjects were 85.3% White, 13.8% Black, and 0.9% other races. Only 0.6% of men were Hispanic. By stage, 84.6% (N=94753) had localized PCa, 10.4% (N=11640) had regional PCa, and 5.0% (N=5571) had distant PCa. The median ADI was 93.9 (IQR 83.6-106.5). Our analysis showed that Black men had 41.8% higher odds of having metastatic PCa at diagnosis than White men. Furthermore, our analysis showed similar risk of metastatic PCa at diagnosis in lower ADI values but higher risk at higher ADI values (Table). Conclusions: Higher ADI values were associated with higher risk of metastatic PCa at diagnosis. Interventions should target populations with socioeconomic deprivation and aim to improve patient access to prostate cancer prevention, screening, and treatment services.