Stereotactic body radiation therapy (SBRT) involves extreme hypofractionation whereby a high dose per fraction, and an overall lower number of fractions than conventional radiotherapy, is used for treatment. Advanced treatment delivery platforms, incorporation of MRI into target localization, motion management and real-time image guidance is required for optimal prostate SBRT delivery. Large published series report long term data of SBRT regimens giving 4 to 5 radiotherapy fractions for low and intermediate risk prostate cancer patients. This data supports prostate SBRT having similar efficacy and toxicity to conventionally fractionated radiotherapy. One recent randomised study comparing conventional fractionation with prostate SBRT reported equivalent tumour control, as well as acute and late toxicity, while several other randomised studies are currently underway exploring similar stereotactic regimens. In response to this growing body of evidence, international guidelines have incorporated prostate SBRT monotherapy as a treatment option for centres experienced in this technique for low and intermediate risk prostate cancer patients. However, the role of SBRT in the management of high risk prostate cancer remains to be determined, including questions of efficacy in this patient cohort, the role of dose escalation, optimal fractionation regimens and the tolerability and efficacy of whole pelvis radiotherapy incorporated in SBRT courses. The next decade will see a major shift towards extreme hypofractionation in the management of prostate cancer.