Radiotherapy is a basic treatment for prostate cancer and this is because it concerns all stages and all patients, even those who cannot undergo surgery.

It has been shown that in the early stages of the disease, it has the same results as prostatectomy in terms of local control of the disease. It is now proven that the optimal therapeutic effect with radiation therapy is achieved by increasing the dose to the prostate. The indicated radiotherapy technique for approaching the prostate is IMRT (intensity modulated radiation therapy) as it causes fewer side effects in healthy tissues for the same doses of radiation while at the same time allowing us to administer larger doses thus increasing the effectiveness of the treatment.

The need to deliver high doses of radiation to the sensitive pelvic area requires the use of techniques that ensure precision and repeatability in targeting so that the healthy organs receive the minimum possible dose. This technique is the so-called IGRT-image guided radiation therapy (radiotherapy guided by images) in which the position of the patient and the pelvic organs are imaged daily and in real time, with the aim of correcting small deviations of the position and the internal normal movement of the organs, just before each session. In this way, the accuracy in placing the patient in the machine is ensured, but the accuracy in the administration of the daily radiotherapy dose is ensured. The aim is to safely increase the dose in the prostate organ and lymph nodes while simultaneously reducing it in the surrounding normal organs and finally, a drastic reduction in toxicity.

The classic radiotherapy regimes of 7-8 weeks have in recent years been replaced by shorter ones of around 4-5 weeks with equivalent effectiveness. Fast regimens (subfractionation) offer advantages such as reduced total treatment time, without an increase in side effects. The above is of particular importance to special groups such as elderly patients, patients with co-morbidities and patients who live in the countryside.

In recent years, the data available on stereotactic radiation therapy to the prostate (SBRT) or ultra-hypofractionation have also matured. It is a very attractive radiotherapy scheme in which the entire dose is administered in very few fractions (5 to 7) and for this reason the use of specialized machines and technology is a necessary condition. Due to the high precision in targeting required and the particular sensitivity of the rectum which is in direct contact with the prostate, stereotactic radiotherapy and hyper-subfractionation are not routine treatments. Studies of prostate stereotaxy are ongoing but currently appear to be an acceptable alternative for carefully selected low- and/or intermediate-risk patients.

Finally, it is important to emphasize that prostate cancer can not only be controlled locally, but also completely cured, either with a combination of therapeutic manipulations, or with local radiation as monotherapy. Radiotherapy is a non-invasive treatment which, with modern machines and techniques, is very well tolerated by patients, ensuring both their healing and their optimal quality of life, both during treatment and in the future.