Definitive radiation therapy is a well-recognised curative treatment option for localised prostate cancer. A suitable technique, dose, target volume, and the option of a combination with androgen deprivation therapy needs to be considered. An optimal standard external beam radiotherapy includes currently the intensity-modulated and image-guided radiotherapy techniques with total doses of ≥76-78 Gy in conventional fractionation. Data from several randomised studies increasingly support the rationale for hypofractionated radiotherapy. A simultaneous integrated boost with dose escalation focused on a computed tomography/positron emission tomography or magnetic resonance imaging/magnetic resonance spectroscopy detected malignant lesion is an option to increase tumour control with potentially no additional toxicity. The application of a spacer is a promising concept for optimal protection of the rectal wall.
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