Stereotactic Body Radiation Therapy (SBRT) for the Treatment of Unfavorable Intermediate-Risk Prostate Cancer

Inclusion Criteria

• Pathologically proven diagnosis of prostate adenocarcinoma within 12 months of enrollment.
• Unfavorable intermediate risk prostate cancer by The National Comprehensive Cancer Network (NCCN) 2021 risk stratification guidelines, including any of the following clinicopathologic features: * Gleason Score 4+3 * >= 50% biopsy cores positive * Two or more of the following risk factors: ** Grade Group 2 or 3 ** cT2b-T2c ** Prostate-specific antigen (PSA) 10 – 20 ng/mL
• Able to undergo magnetic resonance imaging (MRI) for initial staging and MR based radiation planning.
• Sufficient biopsy tissue available for Decipher genomic testing.
• Prostate volume < 90 cc.
• IPSS =< 20.
• Age >= 18.
• Karnofsky performance status (KPS) >= or Eastern Cooperative Oncology Group (ECOG) 0-2.
• Estimated life expectancy > 5 years.
• Willing and able to provide written informed consent and Authorization for Use and Release of Health and Research Study Information (HIPAA authorization).

Exclusion Criteria

• Radiographic T3-T4 detected on staging multiparametric magnetic resonance imaging (mpMRI) * Must be “consistent with” (>90% probability) or suspicious for/probable/probably (75%-90% probability) of T3-T4 disease determined by the reading radiologist.
• Evidence of distant metastases as determined by magnetic resonance imaging (MRI), positron emission tomography (PET), or computed tomography (CT) imaging.
• Evidence of pelvic lymph node involvement as determined by MRI, PET, or CT imaging.
• Prior treatment for prostate cancer including chemotherapy, surgery, or hormonal therapy.
• Prior pelvic radiation.
• Active second malignancy or past history of malignancies diagnosed within the last 2 years that requires active therapy and/or in remission, with the exception of resected non-melanoma skin cancers, non-muscle invasive bladder cancer, stage I head and neck cancer, or stage I colorectal cancer.
• Transurethral prostatic resection (TURP) or greenlight photoselective vaporization of the prostate (PVP) within 6 months of enrollment.
• History of Crohn’s disease or Ulcerative Colitis.