Prostate cancer is the second most frequent malignancy in males worldwide. Tumors up to clinical stage T2c (involvement of both lobes without evidence of extracapsular disease), irrespective of the prostate-specific antigen (PSA) level or the Gleason score, are considered localized disease. A life expectancy of at least 10 years is considered to be required to benefit from curative treatment of localized prostate cancer. There are immediate curative (radical prostatectomy, radiotherapy), deferred curative (active surveillance or active monitoring), or non-curative conservative (watchful waiting) and several experimental treatment approaches for localized prostate cancer. The side effects of treatment of localized prostate cancer include urinary incontinence, erectile dysfunction, and radiogenic bowel disease. Radiotherapy in intermediate and high risk disease should be combined with temporary androgen deprivation. Androgen deprivation may be associated with deterioration of sexual function, hot flushes and metabolic changes like lipid alterations and decreased insulin sensitivity. Adjuvant treatment after radical prostatectomy should be taken into consideration for patients with pT3 disease with positive margins (adjuvant radiotherapy) and with lymph node metastases (adjuvant androgen deprivation and radiotherapy). Besides a disease-specific history, PSA measurement is the backbone of follow-up after treatment for localized prostate cancer.