Background: Few studies have reported long term quality of life after primary treatment for localized prostate cancer. The objective of this study was report 10 year sexual and urinary quality of life data for men undergoing various treatments in the Cancer of the Prostate Strategy and Research Endeavor database. Methods: Men who have been treated for localized prostate cancer and have baseline and follow up quality of life date made up the study cohort. Primary treatment modalities included radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), cryotherapy (CT), primary androgen deprivation therapy (ADT), and active surveillance/ watchful waiting (AS/WW). Sexual and urinary quality of life were assessed by the validated UCLA Prostate Cancer Index and measured on a scale from 0-100. Mixed model repeated measures analysis was used to assess the association between primary treatment modality and long term urinary and sexual quality of life. Results: 3, 772 men made up the study cohort. Among all men being treated for prostate cancer the mean urinary function score was 92 at baseline, 76 at 1 year, 81 at 5 years and 77 at 10 years. Urinary bother scores were 84 at baseline, 71 at 1 year, 82 at 5 years, and 78 at 10 years. With respect to sexual function the mean score was 49 at baseline, 23 at 1 year, 29 at 5 years, and 24 at 10 years. Finally, the mean sexual bother score was 59 at baseline, 37 at 1 year, 46 at 5 years, and 47 at 10 years. With respect to quality of life by primary treatment modality most treatments showed a similar pattern of decreased scores in the first year followed by an increased in the following two years and a plateau up to the 10 year mark. EBRT and BT showed a longer decline in sexual and urinary function post treatment while RP scores plateau after 3 years. Conclusions: Men undergoing primary treatment for localized prostate cancer experience declines in sexual and urinary function and bother in the first year which improves after 3 years and plateaus up to 10 years.