Genitourinary cancers including prostate, bladder, renal, and testicular cancers are among the most prevalent malignancies worldwide, accounting for over 13% of total cancer incidence in 2022. Radiation therapy is considered a key component in the treatment of these cancers. Innovations such as intensity-modulated radiation therapy, volumetric-modulated arc therapy, and image-guided radiation therapy have redefined prostate cancer radiotherapy. Stereotactic body radiotherapy has become an established frontline alternative to long-course treatment schedules for localized prostate cancer. Radioligand therapy has emerged as a standard treatment option for managing metastatic prostate cancer. For muscle-invasive bladder cancer, chemoradiation has proven to be an effective alternative to radical surgery. Stereotactic ablative radiotherapy is now regarded as a viable treatment option for both primary and metastatic renal cell carcinoma. This chapter summarizes recent advancements in the radiotherapeutic management of genitourinary malignancies.