Role of fractionation, type of beam and selection of target volume concepts in external beam radiotherapy

External beam radiation therapy (EBRT) is a curative treatment option for all T-stages of prostate cancer. Recent technological developments and radiobiological aspects are implemented in treatment planning and delivery of modern EBRT. New fractionation regimens, different radiation treatment modalities (photons and protons) and current target volume concepts of prostate cancer are discussed. The discussions in the current literature, reviews and national and international guidelines were used. Dose prescription for prostate cancer was individualized with dose escalation (to a total dose of 80 Gy). New fractionation regimens (hypofractionation) are investigated. Multiparametic imaging procedures, such as positron emission tomography (PET) and magnetic resonance imaging (MRI) are integrated into the treatment planning of radiotherapy. High precision linear accelerator (LINAC) based radiation treatment is available in Germany. An increasing number of centers provide particle beam therapy; however, whether physical advantages of protons or heavy ions convert to measurable clinical benefits still has to be evaluated. LINAC-based radiotherapy has increased precision by implementing multiparametic imaging and image-guided radiotherapy as well as efficacy by dose escalation with a lower risk of toxicity compared to conventional radiotherapy. Recent developments including hypofractionation and particle beam therapy need further scientific evaluation in prospective trials.