A patient needs to be aware of all treatment options to assess which fits best with individual goals. Objective of this study is to assess the association between value markers (utility levels) and treatment choice in men with localized prostate cancer. In this randomized controlled trial, localized prostate cancer patients were randomized to a preference assessment intervention, PreProCare, or to usual care. Patient reported outcomes were assessed at baseline, and at 3, 6, 12 and 24-month follow-up. Treatment choice and other clinical data were obtained from medical charts. We compared treatment choice across intervention groups by prostate cancer risk categories. Hierarchical Bayesian random effects model generated utilities and mean relative importance scores of treatment attributes. For low-risk patients from intervention group, GLM log-link model was used to analyze the association between value markers of treatment attributes and uptake of active surveillance. Total of 743 localized prostate cancer patients were randomized to the PreProCare intervention (n=371) or to usual care (n=372). Demographics and clinical characteristics were comparable by intervention status. Among low-risk patients, higher proportion from intervention group was receiving active surveillance, compared to usual care group (P <.001). Among 117 low-risk prostate cancer patients from intervention group, older age (OR=1.2, CI=1.09, 1.31), sexual function (OR=1.5, CI=1.1, 2.1), fear of surgery (OR=1.5, CI=1.1, 2.2), recovery time (OR=1.1, CI=1.02, 1.9) were associated with higher odds of being on active surveillance. Survival (OR=0.68, CI=0.49, 0.96) was associated with lower odds of being on active surveillance. We observed that patient treatment choice aligned with their values. Value markers (or utility levels) of treatment such as survival, recovery time and sexual function were associated with active surveillance in low-risk prostate cancer patients. Preference assessment intervention can help prostate cancer patients reveal their preferences, leading to better alignment with treatment decision.