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External beam radiotherapy, brachytherapy boost and androgen deprivation therapy is the evidence-based standard of care for unfavourable (unfavourable intermediate and high) risk prostate cancer.  The data supporting the use of elective whole pelvic radiotherapy is conflicting with the definitive study (NRG 0924) not expected to read out for another decade.

There are good data to support the use of stereotactic body radiotherapy (SBRT) in intermediate risk patients but limited data for unfavourable risk patients.  We will review the prospective studies that have been reported for these patients using SBRT as well as the studies that have been completed or are enrolling that will provide evidence for the use of SBRT (including the role of microboosting).