MRI Guided Radiation Therapy for the Treatment of High Risk Prostate Cancer

Inclusion Criteria: * Age: above 18 years * Participants must be histologically proven, adenocarcinoma prostate * Localized to the prostate without positive pelvic lymph node involvement * No distant metastatic disease assessed by pretreatment PSMA PET or bone scan and CT scan * High risk prostate cancer as defined by National Comprehensive Cancer Network (NCCN): Gleason score of 8- 10, clinical stage T3a or higher, or prostate specific antigen (PSA) \> 20 ng/mL * Ability to receive long term hormone therapy * Karnofsky performance score (KPS) \> 70 * No prior history of therapeutic irradiation to pelvis * Patient willing and reliable for follow-up and quality of life (QOL) * English speaking/reading Exclusion Criteria: * Evidence of distant or pelvic metastasis at any time since presentation * Life expectancy \< 2 years * Previous radiation therapy (RT) to prostate or prostatectomy * A previous trans-urethral resection of the prostate (TURP) * Severe urinary symptoms or with severe International Prostate Symptom Score (IPSS) score despite being on hormonal therapy for 6 months which in the opinion of the physician precludes RT * Patients with known obstructive symptoms with stricture * Any contraindication to radiotherapy such as inflammatory bowel disease