Objective: To examine the relationship between health behaviours, masculinity, quality of life, and psychological distress in men with prostate cancer.

Methods: We conducted a prospective study of 225 men with prostate cancer. Men completed baseline and 12‐month follow up assessments. Measures included the Health Behaviours Inventory 20; the Masculinity in Chronic Disease Inventory 22; Brief Symptom Inventory 18; the Expanded Prostate Cancer Index Composite; the Short Form Health Survey 36.

Results: Higher engagement in the proper use of health care resources predicted lower bowel (p = 0.002) and urinary bother (p < 0.001), lower psychological distress (p < 0.001), and better mental health (p = 0.023). Risky substance use behaviours predicted increased urinary bother (p = 0.024). Greater endorsement of family responsibilities predicted lower psychological distress (p = 0.015) and better mental health (p = 0.036). Greater endorsement of optimistic capacity (p = 0.040) and strength (p = 0.036) predicted lower sexual bother. Greater endorsement of action approach (p = 0.012) predicted increased sexual bother. Older age predicted greater psychological distress (p = 0.007), poorer physical quality of life (p = 0.049), and poorer mental health (p = 0.008).

Conclusions: Engagement in health behaviours and endorsement of masculine ideals emerged as having potential to play a role in improving the quality of life and psychological distress of men with prostate cancer. Particularly, men who utilised health care resources and identified strongly with masculine ideals concerning family responsibilities, optimistic capacity and strength had better quality of life and psychological distress.