The balance between tumour control and normal tissue damage with conventional radiotherapy is critical to outcome and morbidity in the treatment of localised prostate cancer. Recent technological advances have allowed a reduction in the amount of normal tissue included in target treatment volumes. This reduces morbidity and allows dose escalation, theoretically increasing the likelihood of tumour control. The methods used to achieve dose escalation are discussed and the available evidence for their safety and efficacy, relative to conventional treatment, is reviewed. Although there are no randomised studies to provide evidence of increased survival, the available evidence supports the hypothesis that dose escalation produces survival rates equivalent to surgical series and provides a realistic choice for patients.