Intensified approaches translated in the past decade into substantial survival gains, especially in patients receiving radiotherapyfor high-risk prostate cancer. It remains that not all of our patients derive benefit from them, underscoring our need to integrate prognostic factors, whether including baseline or treatment response parameters, into our therapeutic decisions. As de-escalated strategies are increasingly applied for patients with prostate cancer, we aimed to review de-escalation approaches for patients with localized disease, either concerning dose, volume, number of fractions or need for systemic therapy.