Objectives <p>To evaluate characteristics of diffusion kurtosis imaging (DKI), baseline prostate-specific antigen (PSA) and postoperative histopathological findings associated with biochemical recurrence (BCR) of prostate cancer (PCa) after radical prostatectomy (RP).</p> Materials &amp; Methods <p>Totally, 44 BCR patients and 72 non-BCR patients who underwent RP from April 2019 to March 2021 were retrospective collected. Baseline PSA, parameters of DKI and histopathological characteristics of the patients were evaluated. Continuous variables were compared by independent sample t-test, and categorical variables were compared by Chi-square test and Fisher's exact test. Cox regression analysis was used to analyze the association between relevant characteristics and BCR. p&lt;0.05 was considered statistically significant.</p> Results <p>Results of univariate Cox regression analysis showed that baseline T-PSA (p&lt;0.001), F-PSA (p=0.034), F/T-PSA (p&lt;0.001), mean diffusivity (MD) (p=0.002), mean kurtosis (MK) (p&lt;0.001) and apparent diffusion coefficient (ADC) (p=0.021) values, ISUP grade group 4 or 5 (p&lt;0.001), positive extraprostatic extension (EPE) (p&lt;0.001), positive perineural invasion (p=0.041), Positive surgical margin (p=0.001) and positive lymphovascular invasion (p&lt;0.001) were correlated with BCR. However, results of multivariate Cox regression analysis showed that baseline T-PSA (HR=10.579; 95% CI, 4.405–27.670; p&lt;0.001), MK value (HR=3.034; 95% CI, 1.809–5.089; p&lt;0.001), ISUP grade group 4 or 5 (HR=3.121; 95% CI, 1.352–7.209; p=0.008), positive EPE (HR=2.219; 95% CI, 1.058–4.651; p=0.035) and positive surgical margin (HR=2.816; 95% CI, 1.585–4.845; p=0.025) were independent risk factors for BCR.</p> Conclusion <p>MK value, as well as baseline F-PSA, ISUP grade group 4 or 5, positive EPE and surgical margin were associated with BCR of PCa after RP.</p>