CT-guided Stereotactic Body Radiation Therapy and MRI-guided Stereotactic Body Radiation Therapy for Treating Prostate Cancer, MIRAGE Study

Inclusion Criteria

• Histologically confirmed, clinical localized adenocarcinoma of the prostate
• No evidence of disease beyond the prostate and/or seminal vesicles (i.e., no suspicious pelvic lymph nodes or presence of metastatic disease outside the pelvis)
• Staging workup as recommended by the National Comprehensive Cancer Network (NCCN) on the basis of risk grouping: * Low risk: No staging workup required * Favorable intermediate-risk: CT abdomen/pelvis if Memorial Sloan Kettering Cancer Center (MSKCC) nomogram predicts >10% probability of lymph node involvement * Unfavorable intermediate-risk: technetium bone scan, CT abdomen/pelvis if MSKCC nomogram predicts >10% probability of lymph node involvement * High-risk: technetium bone scan, CT abdomen/pelvis if MSKCC nomogram predicts >10% probability of lymph node involvement * Advanced imaging studies (i.e. prostate-specific membrane antigen positron emission tomography [PSMA PET] and Axumin scan) can supplant a bone scan if performed first
• Age >= 18
• Ability to understand, and willingness to sign, the written informed consent

Exclusion Criteria

• Patients with neuroendocrine or small cell carcinoma of the prostate
• Patients with any evidence of distant metastases. Note, evidence of lymphadenopathy below the level of the renal arteries can be deemed loco regional per the discretion of the investigator
• Prior whole gland cryosurgery, high intensity focused ultrasound (HIFU) or brachytherapy of the prostate
• Prior pelvic radiotherapy
• History of Crohn’s disease, ulcerative colitis, or ataxia telangiectasia
• Contraindications to MRI, including: * Electronic devices such as pacemakers, defibrillators, deep brain stimulators, cochlear implants; * Metallic foreign body in the eye or aneurysm clips in the brain; * Severe claustrophobia