Optimal management of radiotherapy for prostate cancer patients has become a major concern for physicians in Japan. We reviewed published reports identifying the differences in the patterns of care for prostate cancer patients treated with radical external beam radiotherapy in Japan, Germany, and the United States. The reports indicate that Japanese patients have more advanced primary disease than patients in Germany or the United States. These patient characteristics for Japan and the United States have been almost unchanged for several years. Regarding radiotherapy, conformal radiotherapy was less frequently administered to patients in Japan than patients in Germany or the United States, and the total radiation dose was higher in Germany and the United States than in Japan. Concerning changes in trends in the patterns of radiotherapy, the percentage of patients treated with higher dose levels in the United States has rapidly increased, whereas the percentage of patients receiving these dose levels in Japan has remained extremely low. On the other hand, hormonal therapy has been used more frequently in Japan than in Germany or the United States. These findings indicate that patient characteristics and patterns of care for prostate cancer in Japan are considerably different from those in Germany or the United States.