Background: Optimal management of patients with low-risk prostate cancer (LRPC) remains a topic of debate. While active surveillance (AS) is an increasingly popular option, definitive local treatments, including radical prostatectomy (RP), external beam radiotherapy (EBRT), and prostate seed implantation (PSI), are also commonly used. This study assessed the treatment outcomes of patients with LRPC using a large patient population from the National Cancer Database (NCDB). Methods: We analyzed data from 195,452 patients diagnosed with LRPC between 2004 and 2015 using NCDB. Patients were classified based on their treatment modalities, including RP, EBRT, PSI, or no local therapy (NLT). Only patients with Charlson-Deyo comorbidity scores of 0 or 1 were included. Propensity score analysis was used to balance the treatment groups, and the accelerated failure time model was used to analyze the survival rates of the treatment groups. Results: After a median follow-up of 70.8 months, 24,545 deaths occurred, resulting in an all-cause mortality rate of 13%. Compared to NLT, RP significantly improved overall survival by 47% (1.47, p< .0001), 34% (1.34, p< .0001), 27% (1.27, p< .0001), and 10% (1.10, p = .0002) in the age groups < 60, 60-64, 65-69, and 70-74, respectively. However, the benefit of RP decreased with advancing age, leading to an 11% decrease in survival (0.89, p< .0001) in men aged ≥ 75 years. In contrast, EBRT did not improve overall survival in younger age groups; rather, it decreased survival by 11% (0.89, p = .0020) and 9% (0.91, p = .0111) in patients aged < 60 and 60-64, respectively. However, EBRT significantly improved overall survival in older patients by 6% (1.06, p = .0160) and 27% (1.27, p< .0001) for those aged 70-74 and over 75 years, respectively. Similarly, PSI did not improve overall survival in age groups younger than 64 years but exhibited significant overall survival benefits of 6% (1.06, p = .0242), 11% (1.11, p<.0001), and 34% (1.34, p< .0001) compared to NLT in age groups of 65-69, 70-74, and over 75, respectively. Conclusions: RP improves overall survival in patients with LRPC, especially in younger patients. EBRT and PSI primarily benefit older patients. NLT is a reasonable choice, particularly in younger patients when RP is not chosen. The study is hypothesis-generating and limited by the non-randomized, retrospective, and inherited nature of the NCDB data, which does not provide information regarding patients’ symptoms, sexual function, and disease-specific survival.