I researched the stats on this:
When comparing radical prostatectomy (surgical removal) vs radiation therapy for localized prostate cancer, the risk of recurrence is often discussed in terms of biochemical recurrence, which is usually measured by rising PSA levels after treatment. Actual recurrence with detectable metastases is lower but related to the same risk trends.
Here’s a summary from studies and large reviews:
1. Radical Prostatectomy (RP)
For low- to intermediate-risk prostate cancer, 5–10 year biochemical recurrence rates are roughly 15–30%.
Risk increases with high-risk features (Gleason 8–10, positive margins, extraprostatic extension), where recurrence can be 30–50%.
Long-term (10–15 year) recurrence risk in high-risk patients can be up to 50%, especially without adjuvant therapy.
2. Radiation Therapy (External Beam or IMRT)
For low- to intermediate-risk disease, 5–10 year biochemical recurrence is generally 20–35%.
High-risk patients may see recurrence rates of 40–60% over 10 years.
Key Points
1. Direct comparison is tricky: Surgery often gives more precise PSA monitoring (undetectable PSA after surgery is easier to interpret). Radiation leaves the prostate in place, so PSA nadir can be higher and slower to reach.
2. High-risk patients benefit from combined therapy: Radiation + ADT or surgery + adjuvant therapy reduces.

Note: These numbers are general population statistics. Individual risk can vary widely depending on Gleason score, PSA, margins, lymph node involvement, and response to therapy.