The incidence of advanced prostate cancer has decreased since the introduction of prostate-specific antigen (PSA) measurements. The treatment of these patients remains a challenge due to the bad prognosis and continues to be controversially discussed. The article discusses the questions concerning radiotherapy including pelvic lymph nodes as well as an additional androgen deprivation therapy. The risk of recurrent cancer has increased since the introduction of radical prostatectomy for patients with high risk factors or locally advanced tumors. In these cases adjuvant and salvage radiotherapy represent a mainstay of therapy. Low-dose rate (LDR) and high-dose rate (HDR) brachytherapy are primary treatment options for patients with low and high risk factors and localized disease. An elaborate management of treatment-related toxicities is mandatory and may provide persistent symptom relief. A comprehensive assessment of radiation side effects and treatment concepts is provided. The development of secondary cancers after radiotherapy represents a most severe side effect for which an assessment of available data is presented.