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Objectives This study aimed to explore whether alternative diagnostic labels to communicate a hypothetical low-risk prostate cancer diagnosis influenced management choice and level of anxiety. It further sought to test whether providing absolute risk information about the benefits and harms of different management strategies modified any diagnostic label effects.Methods Factorial (3 x 2) randomised online hypothetical experiment. Participants were randomised 1:1:1 using Qualtrics survey software to: ‘low-risk prostate cancer, Gleason Group 1’, ‘low-risk prostate neoplasm’, or ‘low-risk prostate lesion’. A second randomisation then allocated them 1:1 to detailed information on the benefits and harms of different management choices versus less detailed information about management choices. Participants were Australians with a prostate (regardless of gender), aged 50 years or older, who could understand written English. People with a history of prostate cancer were excluded.The primary outcome was management choice: conservative management with no immediate treatment (PSA monitoring or active surveillance) vs curative management with immediate treatment (prostatectomy or radiation therapy). Secondary outcomes included proportions choosing each individual management option, diagnosis anxiety, management choice anxiety, open-text explanation of choice, and choice of definitive treatment after five years of conservative management.Analysis used an intention to treat approach, using multi-arm analyses (‘inside the table’).Results 1402 people were recruited and randomised between 11 th April and 5th June 2024, with 42 people not finishing the survey and 20 excluded. Of the 1340 people (1284 males, 56 non-males) included in analysis, 666 (50%) chose PSA monitoring (PSA tests only), 499 (37%) active surveillance (PSA tests, MRIs, biopsies), 88 (6.7%) prostatectomy, and 88 (6.7%) radiotherapy.Compared with ‘low risk prostate cancer’, ‘low risk prostate neoplasm’ reduced the odds of choosing immediate treatment (OR = 0.55, 95% CI: 0.36–0.85, p = 0.007), whereas ‘low risk prostate lesion’ did not (OR = 1.00, 95% CI: 0.67–1.48, p=.98). Multi-arm analysis found that compared to control label and low information, those assigned to ‘low risk prostate lesion’ and high information were least likely to choose immediate treatment (OR=0.31, 95% CI: 0.16–0.60, p<.001).Conclusions Regarless of the label, a high proportion of people with a low risk prostate lesion may choose PSA monitoring alone if this is offered to them. The diagnostic label ‘neoplasm’ may support patients to choose conservative management rather than invasive treatment. Clear communication on the benefits and harms of treatment options may not be effective as a sole intervention to overcome the ‘cancer’ label effect. However it may be synergistic to the effects of the new label ‘low risk prostate neoplasm’, further increasing the probability of a conservative management choice.