Hormone Therapy and Radiation Therapy in Treating Patients with Non-metastatic, Intermediate, or High Risk Prostate Cancer

Inclusion Criteria

• Age >= 70 years AND/OR Charlson comorbidity index score >= 2 (prostate cancer diagnosis does not contribute to total score)
• Pathologically (histologically) proven diagnosis of prostatic adenocarcinoma
• Intermediate or high risk for recurrence according to the following criteria: * Two or more of the following intermediate risk features for recurrence ** Gleason score = 7 ** Prostate-specific antigen (PSA) 10-20 ng/ml ** Clinical stage T2b-T2c ** Percent positive biopsy cores >= 50% OR * One or more of the following high risk features for recurrence ** Gleason score 8-10 ** PSA > 20 ng/ml ** Clinical stage T3a-T4
• Clinically negative lymph nodes as established by imaging (pelvic +/- abdominal computed tomography [CT] or magnetic resonance imaging [MRI]), nodal sampling, or dissection, except as noted immediately below: * Patients with intermediate risk factors only do not require abdominopelvic imaging, but these studies may be obtained at the discretion of the treating physician * For men with any high risk feature (PSA > 20, Gleason score > 8, or clinical stage T3), a pelvic CT or MRI, are required; it is recommended that the duration between these scans and study registration be less than 60 days, but if the time period is > 60 days and the opinion of the clinician is that repeat studies would offer limited benefit, then these studies do not need to be repeated; a lymph node will be considered radiographically positive if it is > 1.5 cm in size, occurs within the expected distribution for prostate cancer metastasis (i.e. internal iliac or obturator fossa), and is without classic benign features (i.e. fatty hilum); patients with lymph nodes equivocal or questionable by imaging are eligible for inclusion in this study
• No evidence of bone metastases (M0) on bone scan * Patients with intermediate risk factors only do not require a bone scan, but these studies may be obtained at the discretion of the treating physician * Patients with any high risk factors are required to undergo a bone scan; it is recommended that the duration between these scans and study registration be less than 60 days, but if the time period is > 60 days and the opinion of the clinician is that repeat studies would offer limited benefit, then these studies do not need to be repeated * Equivocal bone scan findings are allowed if additional imaging (e.g. plain film x-rays, or CT) does not confirm metastasis
• History/physical examination to include, at a minimum, digital rectal examination of the prostate and examination of the skeletal system and abdomen, and formal comorbidity assessment via the Charlson Comorbidity Index within 60 days prior to registration
• Zubrod performance status 0-2
• Baseline serum PSA value performed with a Food and Drug Administration (FDA)-approved assay (e.g., Abbott, Hybritech) within 60 days prior to registration
• Baseline serum testosterone obtained within 60 days prior to registration
• Study entry PSA and serum testosterone must not be obtained during the following time frames: (1) 10-day period following prostate biopsy; (2) following initiation of oral androgen manipulation; (3) within 30 days after discontinuation of finasteride or dutasteride
• Absolute neutrophil count (ANC) >= 1,800 cells/mm^3
• Platelets >= 100,000 cells/mm^3
• Hemoglobin >= 8.0 g/dl (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)
• Patient must be able to provide study-specific informed consent prior to study entry
• Total bilirubin =< 2 x institutional upper limit of normal
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) or alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal

Exclusion Criteria

• Prior radical surgery (prostatectomy), high-intensity focused ultrasound (HIFU) or cryosurgery for prostate cancer
• Prior hormonal therapy, such as luteinizing hormone-releasing hormone (LHRH) agonists (e.g., goserelin, leuprolide), antiandrogens (e.g., flutamide, bicalutamide), estrogens (e.g., diethylstilbestrol [DES]), or bilateral orchiectomy
• Use of 5-alpha reductase inhibitors (finasteride, dutasteride) specifically prescribed for the treatment of prostate cancer
• Prior or concurrent cytotoxic chemotherapy for prostate cancer; prior chemotherapy for a different cancer is permitted
• Prior radiation, including brachytherapy, to the region of the prostate that would result in overlap of radiation therapy (RT) fields
• Active lupus or scleroderma
• Severe, active co-morbidity, including but not limited to: * Unstable angina within the last 6 months without subsequent corrective cardiovascular procedure * Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration * Hepatic insufficiency with AST, ALT, or bilirubin > 2 x upper limit of normal, clinical jaundice, and/or coagulation defects * Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol; patients who are HIV seropositive but do not meet criteria for diagnosis of AIDS are eligible for study participation