Radiation Treatment of the Prostate That is Specially Adjusted for Each Person

Inclusion criteria

• Histologically confirmed adenocarcinoma of the prostate
• NCCN risk grouping of intermediate or high risk prostate cancer
• Patients must be 18 years of age, or older on the day of signing informed consent and be willing and able to provide written informed consent/assent
• Identifiable lesion within the epithelium of the prostate as determined by the treating radiation oncologist
• Have a prostate imaging reporting and data system (PIRADS) 4 or 5 nodule noted on MRI
• Have not received prior pelvic radiotherapy
• Life expectancy greater than 10 years
• ECOG performance status <3
• Eligible for SBRT to the prostate

Exclusion criteria

• No identifiable lesion within the prostate on 3T MRI
• Prior trans-urethral resection of the prostate
• Non-adenocarcinoma histology
• Meeting criteria for very high-risk risk or node positive prostate cancer
• Active inflammatory bowel disease
• Evidence of metastatic disease on CT or bone scan
• Declined radiotherapy
• Unlikely to be available for all follow-up appointments
• Having received androgen deprivation therapy or 5-alpha reductase therapy prior to trial therapy
• Extensive disease in the posterior prostate or aberrant anatomy that makes the safe delivery of boost irradiation not feasible
• Unable to understand or sign a study consent form after use of interpreter if required
• Has a relative contraindication to radiotherapy including systemic lupus erythematosus, TNM deficiency or scleroderma
• Unable to tolerate or ineligible for mpMR imaging
• Any condition or diagnosis, that could in the opinion of the treating physician or qualified investigator interfere with the participant's ability to comply with study instructions, might confound the interpretation of the study results, or put the participant at risk