In recent years, the incidence of prostate cancer in China has been increasing. Those who suffer from prostate cancer, especially the elderly, often worry about the trauma, risks and complications associated with surgery when they opt for radical treatment. So, can prostate cancer be cured without surgery? In April 2012, Warren Buffett, the famous American investor known as the “God of Stock”, announced that he had prostate cancer, and that he was 82 years old at the time. eager to return to work. His choice and the results of his treatment have attracted the attention of many national media. Why did Buffett choose precision radiation therapy over surgery? Can precise radiotherapy cure prostate cancer as well as surgery? In fact, in foreign countries, it is more common for prostate cancer patients to choose precision radiation therapy. This is because prostate cancer patients can get the same curative effect with surgery and radiation therapy. And the most important feature of radiation therapy is that it is non-invasive, which avoids the various complications and risks associated with surgery. As early as 2002, a comparison was made between surgery and radiation therapy for the radical treatment of prostate cancer. In the past 20 years, with the application of second-generation radiotherapy techniques, conformal and intensity-modulated radiation therapy, modern radiotherapy techniques are able to accurately deliver higher doses of radiation to the tumor and kill the tumor cells more completely, thus bringing higher cure rates. Kuban et al. reported that after 8.7 years of follow-up, nearly 80% of prostate cancer patients treated with conformal and intensity-modulated radiotherapy had no tumor recurrence and remained in a healthy state. At the same time, the advent of image-guided technology (IGRT) is like providing a high-precision scope for a sniper rifle, further improving the accuracy of precise radiation therapy, increasing efficacy and reducing side effects. As a result, radiotherapy has been widely used as the first radical treatment for prostate in areas with a high incidence of prostate cancer, such as the United States, where, according to statistics, nearly 40% of prostate cancer patients currently receive radical radiotherapy. As early as 2008, a panel of experts from the National Comprehensive Cancer Collaborative Network agreed that radiation therapy is as effective as surgery for prostate cancer and can avoid the complications and risks associated with surgery, making it an alternative treatment to surgery. In addition to its comparable efficacy to surgery, radiation therapy has significant advantages over surgery: first, it avoids complications associated with surgery, such as bleeding, transfusion-related complications, and anesthesia accidents. Secondly, the risk of urinary incontinence and urethral stricture after radiation therapy is much lower than that of surgery, and there is a better protection of the erectile function of male sexual function. The rate of urinary incontinence after surgery is 14% compared to 4% after radiotherapy; the chance of erectile dysfunction after radiotherapy is 20% lower than after surgery [[3]]. In addition, due to the non-invasive nature of radiation therapy, radiation therapy is suitable for people of different ages, and the advantages of precise radiotherapy are more obvious especially for elderly patients, as well as for patients who are weak and cannot tolerate surgery due to the combination of many other diseases. Of course, radiation therapy can also produce urinary tract irritation such as urinary frequency, urinary urgency, and radioactive proctitis. However, with the use of precise radiotherapy, the treatment accuracy is controlled to millimeter, and if the world’s most advanced volumetric intensity modulated radiotherapy (VMAT) combined with image guided technology (IGRT) and appropriate anti-inflammatory treatment, it is basically possible to treat the tumor precisely while keeping the discomfort and side effects caused by radiotherapy to a minimum. Therefore, patients with prostate cancer, especially elderly patients, patients with multiple comorbidities and patients who focus on the quality of life after treatment, can give priority to radical precision radiotherapy. However, please make sure to choose a standardized and experienced large oncology radiation treatment center. We hope that prostate cancer patients will receive radical treatment and recover as soon as possible.