Background: Prostate cancer treatment has been widely associated with developing and/or worsening metabolic syndrome. While numerous studies have explored the interplay between prostate cancer and metabolism, there have been very few studies investigating endocrine and metabolic disease diagnoses among prostate cancer survivors with long term follow up. The aim of this study is to examine the incidence of endocrine and metabolic disease among prostate cancer survivors compared to a general population cohort. A secondary aim is to investigate risk factors for endocrine and metabolic disease among prostate cancer survivors. Methods: Cohorts of 18,134 cancer patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73,470 men without cancer matched by age, birth state and follow up time from the general population were identified. Incidental endocrine and metabolic diseases diagnoses were identified from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios (HRs). Results: Prostate cancer patients had increased risks of endocrine and metabolic diseases for the overall 16-year follow-up after cancer diagnosis (1-5 years: HR=1.26, 99%CI=1.22-1.31; 5-10 years: HR=1.21, 99%CI=1.16-1.26; 10-16 years: HR=1.20, 99%CI=1.12-1.28) compared to the general population. Elevated risks of thyroid disorder among prostate cancer patients were observed across follow-up periods (1-5 years: HR=1.19, 99%CI=1.11-1.28; 5-10 years: HR=1.12, 99%CI=1.03-1.22; 10-16 years: HR=1.17, 99%CI=1.02-1.35). Similarly, disorders of lipid metabolism risks were higher for all follow-up periods (1-5 years: HR=1.53, 99%CI=1.41-1.66; 5-10 years: HR=1.21, 99%CI=1.15-1.26; 10-16 years: HR=1.20, 99%CI=1.11-1.29). The risks of obesity and diabetes mellitus were also increased within 1-10 years and 1-5 years, respectively. Risk factors for endocrine and metabolic diseases among prostate cancer survivors included non-Hispanic ethnicity, unhealthy BMI, CCI≥1, family history of cancer, older age at diagnosis, and higher cancer stage throughout the overall follow-up periods after prostate cancer diagnosis. Significant risk factors for endocrine and metabolic diseases within 1-10 years after prostate cancer diagnosis included family history of prostate cancer, single marital status, government health insurance, high socioeconomic level, and high household incomes. Moreover, prostate cancer survivors with a diagnosis of endocrine and metabolic diseases faced a 13% increased risk of death. Conclusions: This study highlights a heightened risk of endocrine and metabolic diseases among prostate cancer survivors throughout the entire follow-up period after cancer diagnosis. It underscores the importance of multidisciplinary care to monitor and manage endocrine and metabolic diseases in this population of survivors.