Radiation therapy modalities have been shown to offer patients a nonoperative option for definitive treatment of localized prostate cancer as well as options for adjuvant or salvage therapy in high-risk prostate cancer patients. In patients with high-risk, localized disease, radiation therapy with or without adjuvant hormonal therapy is considered an excellent treatment option because of its efficacy within the prostate and among local periprostatic structures, addressing micrometastatic disease. Following radical prostatectomy in patients with high-risk or recurrent disease, radiotherapy can increase oncologic efficacy in both the adjuvant and salvage setting. Continued studies are underway to address ongoing concerns of sparing surrounding tissues unnecessary radiation while administering high-dose radiation to the prostate and targeted periprostatic structures. Newer technologies are using real-time imaging and computer-simulated motion calculation to adjust for physiological organ motion with respect to bony landmarks classically used to map areas of radiation administration. Copyright © 2009 by Current Medicine Group LLC.