The optimal therapy for prostate cancer classified as "intermediate risk" on the basis of prostate-specific antigen, Gleason score, and clinical T stage is currently evolving. The role of hormonal therapy in these patients remains controversial, particularly in the setting of dose-escalated radiation. In this review, we examine the currently available data and describe maturing studies that address the optimal timing, duration, and potential risks and benefits of adding hormonal therapy to external-beam radiation for intermediate-risk patients. We conclude that until additional data become available, a short course of androgen deprivation, concurrent with radiation, should be considered in selected intermediate-risk patients who may be at greatest risk for failure if treated with external-beam radiation alone.