MRI-guided Brachytherapy and Salvage SBRT Program

Patients with increasing PSA after RP and clinical evidence of PET PSMA/Choline+ and RMN+ isolated prostatic bed relapse (IPBR) that is implantable via transperineal route . The IPBR should be visible on TRUS imaging to allow proper implant placement. 1. Pathological confirmation is advised in all cases but it is not mandatory . 2. Patients with any of the following were not considered eligible: 1. Distance \< 5mm from the edge of the IPBR to any of the defined OARs (UV anastomosis, rectal wall, bladder wall, external urinary sphincter) 2. Distant Metastases 3. Isolated nodal relapses 4. Prior Irradiation to the IPBR area 5. Multicentric IPBRs 6. Life expectancy of less than 5 years or inability to tolerate and comply with an HDR procedure 3. No prior radiation therapy to the target areas; 4. Karnofsky performance status \> 70 with medical condition not contraindicating treatment with radical intent including maximal TURBT and concomitant chemotherapy; 5. WBC equal or greater than 3500 mm3; platelet count equal or greater than 135000 mm3; hemoglobin equal or greater than 10 gr/L; BUN equal or less than 20; serum creatinine equal or less than 2.0. 6. Ability to undergo MRI scanning.