Background: Prostate cancer is the second leading cause of cancer death among US men and disproportionally impacts Black men. Black men are 2.2 times more likely to die from prostate cancer than non-Hispanic white men. Guidelines recommend that men make an informed decision about prostate cancer screening following a conversation with their clinician about risks and benefits. Despite known racial prostate cancer disparities, Black men receive PSA screening at lower rates than Non-Hispanic White men. Black men also report inadequate education to make informed decisions about prostate cancer screening. Little is known contemporarily about how often shared decision-making (SDM) conversations occur and how they affect rates of PSA tests. The purpose of this project was to determine the extent to which clinicians are documenting prostate cancer shared decision making conversations in men aged 45 to 69, to investigate whether this documentation differs based on patient race, and to examine the relationship between SDM conversations and completion of prostate cancer screening. Methods: This retrospective chart review included 300 Black men and 300 age-matched White men between the ages of 45 and 69 who had an outpatient visit at a Medical University of South Carolina (MUSC) outpatient family medicine clinic from 2019-2020. Frequency of documented SDM conversations by patient race and frequency of PSA ordering by patient race were analyzed using Pearson chi-squares. Multivariable logistic regression was run with documented shared decision-making conversation and screening PSA ordered as dependent variables and patient demographic and clinical data as independent variables. Results: 28.1% of Black men and 29.1% of White men completed PSA screening (p=0.68). 12.1% of Black men and 6.5% of White men had SDM conversations documented (p=0.13). Among 300 Black men, SDM was associated with increased likelihood of screening PSA (p<0.01). SDM was not associated with family history of cancer, colon cancer screening, or insurance. Screening PSA was associated with insurance type among Black men (p = 0.03). Among 300 non-Black men, there was no association between SDM and screening PSA. There was also no association between insurance type and screening PSA. Conclusions: Rates of PSA screening and documented SDM conversations were strikingly low regardless of race at this large academic medical center. It is imperative that primary care clinicians engage in and appropriately document prostate cancer screening SDM conversations in order to uphold the current standard of care and reduce prostate cancer mortality. The increased likelihood of prostate cancer screening in Black men who had SDM conversations stresses the importance of these conversations in the fight to eliminate racial prostate cancer disparities.