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On multivariate analysis, treatment with RT + ADT or RT was associated with significantly worse OS compared to treatment with RP (RT + ADT HR = 2.06, 95% CI 1.67-2.54, P less then .0001; RT HR = 2.0, 95% CI 1.71-2.33, P less then .0001). Patients who met all 3 of the intermediate-risk criteria showed worse OS compared to patients who met only one criterion (HR = 1.80; 95% CI, 1.32-2.44; P = .0002). CONCLUSION RP is significantly more likely than RT + ADT or RT to be used as a primary treatment for young men with localized intermediate prost