OBJECTIVE To assess the statistical relationship between stage at diagnosis of prostate cancer and racial category in 4 southeastern states. METHODS Data from state cancer registries in Florida, Georgia, Kentucky, and Maryland were analyzed using a hierarchical generalized linear model to adjust for both patient-level characteristics and area-based measures of socioeconomic status. RESULTS African American men had lower odds of being diagnosed with localized disease than white men in 3 of the 4 state populations. After adjusting for patient- and area-level characteristics, the difference is that odds were statistically significant for men living in Florida (OR, 0.79, 95% CI, 0.73-0.85) but not in Georgia (OR, 0.84; 95% CI, 0.70-1.01), Kentucky (OR, 1.02; 95% CI, 0.82-1.27) or Maryland (OR, 0.91; 95% CI, 0.74-1.12). CONCLUSIONS Differences in the likelihood of localized prostate cancer diagnosis between African American and white men in 4 states were not statistically different in 3 states after adjustments for individual and census-level characteristics. Variation in the proportion of men diagnosed with localized disease across states may reflect differences in sample size or real differences between the populations of these states.