Clinical Research Directory

Inclusion Criteria: * Age \>45 and Life expectancy \>10 years * Previous External Beam Radiotherapy (EBRT) dose up to 78Gray/39 fractions, 81 Gray/45 fractions or 70 Gray/28 fractions or LDR brachytherapy with site of recurrence in an under-dosed or untreated site * \> 3 year interval since EBRT or LDR Brachytherapy * No late toxicity from prior EBRT ≥ grade 2 * Rising PSA post EBRT \> nadir + 2 ng/ml but \< 10 ng/ml * PSA Doubling time \> 6 months * Negative staging with CT scan of the abdomen/pelvis and bone scan (PSMA PET scan can replace CT and bone scan) * Able to undergo multiparametric MRI with endorectal coil * Radiographic evidence of dominant intraprostatic lesion (DIL) as only area of recurrence (i.e unifocal recurrence) and corresponding to site of original disease * Biopsy confirmation of DIL with pathology review by British Columbia Cancer Agency GenitoUrinary pathologist (TB) * Willing to provide informed consent * History and physical examination within 90 days of registration * ECOG performance status 0-1 prior to registration * IPSS \< 16, or adequate voiding study (post void residual \< 100cc and peak flow rate \> 10 cc/second). * No prior trans urethral prostatic resection * Recurrence suitable for implant with HDR brachytherapy as assessed on ultrasound simulation (maximum PTV ideally \< 65% of prostate volume) * No history of inflammatory bowel disease or previous rectal surgery * Suitable for procedure under anesthesia, spinal or general * INR \<2.5 and platelet count \>75 x 109/L * Androgen Deprivation Therapy may be initiated at the discretion of the treating oncologist Exclusion Criteria: * Not compliant with criteria above * Unable to give informed consent