Background: Mortality among men with biochemical failure (BF) after treatment is variable. We examined the long-term survival of men with BF to determine if differences exist, depending on original treatment modality. Methods: Between 1995 and 2008, 6,084 patients underwent treatment for clinically localized prostate cancer at our institution (4,276 underwent radical prostatectomy (RP); 1,808 underwent EBRT). Clinical information and follow up data was obtained from prospectively maintained databases. Survival was assessed using log rank test. Results: 526 (12%) patients had BF defined by PSA > 0.4 after RP. 326 (18%) patients had BF after EBRT, defined as PSA nadir +2. 197 (60%) of EBRT patients received ADT as neoadjuvant/concurrent/adjuvant therapy. Median overall survival was 154 months (95%CI 148-157) versus 129 months (95%CI 123-135) for RP and EBRT respectively (p<.0001). Median prostate cancer specific survival was 125 months (95%CI 93-148) versus 107 months (95%CI 92-123) for RP and EBRT respectively (p=0.17). There was no difference in prostate cancer specific survival between treatments among patients in D’Amico intermediate and high risk groups. Conclusions: In patients with biochemical recurrence after definitive treatment, patients treated with RP have improved overall survival compared to patients treated with EBRT. However, there is no difference among treatment groups in prostate cancer specific survival.