With the data from the National Cancer Database, this study investigated the utilization pattern and outcomes of IMRT, brachytherapy (BT), PT and SBRT for localized prostate cancer stratified by risk group. The most utilized treatment modality for all PCa patients was IMRT (53.1%). Over the years, a steady increase in SBRT utilization was observed, whereas BT HDR usage declined. IMRT-treated patient groups exhibited relatively lower survival probability in all risk categories. BT, SBRT, and IMRT+BT exhibited similar survival rates. A slightly better survival probability was observed for the PT group across all risk groups.