Overview

The goal of this clinical trial is to compare SBRT (Stereotactic Body RadioTherapy) to LDRB (Low-Dose Rate Brachytherapy with Iodine-125 seed implant) in patients with low and favourable intermediate-risk prostate cancer. The two main questions it aims to answer are :

1. Does SBRT (Stereotactic Body RadioTherapy) for low and intermediate risk prostate cancer patients will result in less genito-urinary (GU) and gastro-intestinal (GI) toxicities than LDRB (Low-Dose Rate Brachytherapy)?
2. Does prostate cancer patients treated by SBRT have a better quality of life than patients treated by LDRB

No randomized trial has yet compared LDRB to SBRT head to head.

Eligibility

Inclusion Criteria:

• Histologically confirmed adenocarcinoma of the prostate diagnosed within the last 8 months. Patients on active surveillance with evidence of disease progression are eligible to the protocol as long as they meet the eligibility criteria and have a recent prostate biopsy (within 8 months).
• Low-risk and favourable intermediate-risk prostate cancer patients are eligible according to the following definitions:

Low-risk disease defined as: Clinical stage T1-T2a and Gleason 6 and PSA ≤ 10 ng/mL

Favourable intermediate-risk cancer defined by a single NCCN intermediate risk factor:

[NCCN : National Comprehensive Cancer Network]

1. Clinical stage T2b
2. PSA > 10 but ≤ 20 ng/mL
3. Gleason 7 (3+4)

        Lymph node evaluation by either computed tomography (CT) or magnetic resonance imaging
        (MRI) is optional and is left at the discretion of the treating physician.
          -  Age ≥ 18 years
          -  Eastern Cooperative Oncology Group performance status 0-1
          -  Patient considered medically fit for LDR brachytherapy
          -  Prostate volume ≤ 60 cc, measured by Trans-Rectal UltraSound (TRUS), CT or MRI, within
             the last 6 months.
          -  International Prostate Symptom Score (IPSS) ≤ 20 (alpha blockers allowed)
          -  No alpha reductase inhibitors use within two weeks of randomization
          -  No hormonal therapy is accepted
          -  Patients must provide a study-specified informed consent form prior to study entry.
          -  Patients must be willing and able to complete the EPIC-26, IPSS and SHIM
             questionnaires.
        [EPIC-26: Expanded Prostate Cancer Index Composite score ; SHIM: Sexual Health Inventory
        for Men questionnaire].
        Exclusion Criteria:
          -  Clinical or radiological evidence of metastatic disease or nodal involvement.
          -  Clinical stage ≥ T2b.
          -  Gleason score ≥ 4 + 3.
          -  Patients with a history of other malignancies, except: adequately treated non-melanoma
             skin cancer, or other solid tumors curatively treated with no evidence of disease for
             ≥ 3 years.
          -  Prior radical surgery for carcinoma of the prostate, or prior TURP (Trans-Urethral
             Resection of the Prostate).
          -  Prior pelvic radiotherapy or prior radiotherapy that would result in overlap of
             radiation fields.
          -  Prior chemotherapy for prostate cancer, or prior chemotherapy within the last 3 years.
          -  Prior cryosurgery of the prostate.
          -  Prior or current bleeding diathesis making fiducial placement or brachytherapy
             procedure unsafe.
          -  Previous androgen deprivation therapy within 6 months of the registration.
          -  Bilateral hip prostheses
          -  Any severe active comorbidity, laboratory abnormality, psychiatric illnesses, active
             or uncontrolled infections, serious illnesses or medical conditions that would prevent
             the patient from participating or to be managed according to the protocol (according
             to investigator's decision). Such examples includes active inflammatory bowel disease,
             significant urinary symptoms,