Background: Both radical prostatectomy and external beam radiation therapy (XRT) are standard therapeutic options for definitive treatment of early-stage prostate cancer. While both modalities are generally viewed as comparable when matched for risk stratification, there is a paucity of literature directly comparing their outcomes. Slow-growing malignancies are generally regarded as less radiation-sensitive, but this has not been conclusively proven in prostate cancer. Aggressive variants of prostate cancer have, however, been shown to have higher rates of radiation-resistance. Here, we present a retrospective database analysis comparing rates of bone metastases and mortality among early-stage prostate cancer patients treated with radical prostatectomy versus XRT. Methods: The TriNetX research network was used for this study, with patient cohorts created by the use of International Classification of Disease 10 (ICD-10) codes and Current Procedural Terminology (CPT) codes. Both cohorts consisted of men over age 50 with a diagnosis of prostate cancer (C61) and PSA levels below 10 ng/mL. One cohort was treated with surgical prostatectomy (1014183 or 55866), while the other underwent Intensity Modulated Radiation Treatment (77385 or 77386). The cohorts were balanced for age, race, and ethnicity by propensity score matching and the greedy nearest neighbor algorithm, resulting in 14,985 patients in each arm. The cohorts were then evaluated for the development of bone metastases (C79.51) and mortality at five years. Results: Patients treated with prostatectomy were less likely to develop bone metastases within five years (3.4% vs 7.6%, RR 0.45, 95% CI (0.41,0.50), P value <0.0001). Prostatectomy was also associated with lower five-year mortality (4.2% vs 7.9%, RR 0.53, 95% CI (0.48,0.58), P value <0.0001). Conclusions: These results indicate that in early-stage prostate cancer, radical prostatectomy is associated with decreased rates of mortality and bone metastases within a 5-year period compared to XRT. Additional studies are needed to determine which prostate cancer variants are at increased risk of radiation treatment failure. Shared decision making regarding both outcomes and side effects is crucial when choosing a modality of definitive treatment in early-stage prostate cancer.