This is a study done on "healthy" adults. There are limitations to this study to be sure. It's a population study, and not addressing the advanced disease. Nonetheless, another data point to keep in mind.
The comparative efficacy of radical prostatectomy (RP) vs radiation (RT) for high-risk prostate cancer remains a source of debate. This study used data from the National Cancer Data Base to compare overall survival with external beam radiation therapy plus brachytherapy (EBRT + BT) versus RP in comparatively young (≤65 years) and healthy men with localized prostate cancer. Median follow-up was roughly 8 years, and nearly 14,000 men were studied. All patients had high-risk disease, and the study did not account for androgen-deprivation therapy. The patients treated with initial EBRT + BT had a higher risk of all-cause mortality (HR, 1.22) compared with those treated with initial RP.
These data indicate that young and healthy men presenting with high-risk, localized prostate cancer have better survival with RP compared with EBRT + BT, challenging prior research suggesting better or equivalent outcomes with radiotherapy."