Metabolic syndrome is associated with an increased risk of finding prostate cancer (PCa) overall and high-grade disease on biopsy. The first objective was to determine if MetS is associated with higher final PCa stage and grade on radical prostatectomy (RP) specimen and the second objective was to determine if MetS is associated with increased risk of recurrence following RP. The study identified 2498 men undergoing RP between 2004 and 2013. Demographic and clinical parameters were collected prospectively while MetS components and medication use collected retrospectively. After exclusions 1939 men were included finally. MetS was defined by ≥3 of 5 components (obesity, dysglycemia, hypertension, low high-density lipoprotein-cholesterol, and high triglycerides). Of 1939 men, 439 (22.6%) had MetS. MetS (≥3 vs. 0 components) was associated with increased odds of Gleason 8-10 disease and extraprostatic disease. Decreased use of nerve-sparing in men with MetS was noted. In unadjusted analyses, MetS was associated with a significantly increased risk of receiving salvage therapy and a near-significant increased overall recurrence risk. These associations were attenuated upon adjusting for disease-specific parameters. In analyses evaluating individual components, no single component of MetS appeared to be the sole driver of observed associations related to MetS as a whole. It is the largest to evaluate MetS in the RP population but there are limitations. First, patients undergoing RP are selected as having clinically localised disease. It is plausible that men with MetS who have locally advanced or metastatic disease may not be suitable for RP, or may not be medically suitable for surgery and therefore our estimates may be somewhat conservative. Second, men with MetS may have had a more aggressive extirpation, as previously discussed. Lastly, longer follow-up may be required to determine if the association between MetS and risk of overall recurrence reaches statistical significance.