Inclusion Criteria:

- Histological confirmation of prostate adenocarcinoma with a minimum of 10 biopsy
cores taken.

- Gleason score ≤ 3+4

- Men aged ≥18

- Clinical and MRI stage T1c -T2c, N0-X, M0-X

- PSA ≤ 20 ng/mL

- Pre-enrollment PSA must be completed within 60 days of registration

- Patients belonging in one of the following risk groups according to the National
Comprehensive Cancer Network:

- Low risk: Clinical stage T1-T2a and Gleason ≤ 6 and PSA < 10 ng/ml, or

- Intermediate risk includes any one of the following:

- Clinical stage T2b or T2c

- PSA 10-20 ng/ml or

- Gleason 7

- WHO performance status 0 - 2

- Prostate volume ≤ 90 cc

- Ability of the research subject or authorized legal representative to understand and
the willingness to sign a written informed consent document

Exclusion Criteria:

- Clinical stage T3 or greater

- Gleason score ≥ 4 + 3

- < 10 prostate biopsies taken

- High risk disease as defined by National Comprehensive Cancer Network (www.nccn.org)

- Previous malignancy within last 5 years except basal cell carcinoma or squamous cell
carcinoma of the skin

- Prior pelvic radiotherapy

- Prior androgen deprivation therapy (including androgen agonists and antagonists)

- Any prior active treatment for prostate cancer

- Life expectancy <10 years

- Bilateral hip prostheses or any other implants/hardware that would introduce
substantial CT artifacts

- Medical conditions likely to make radiotherapy inadvisable eg inflammatory bowel
disease, significant urinary symptoms

- Anticoagulation with warfarin or bleeding tendency making fiducial placement unsafe.

- Medical condition/ implant that prohibits MRI

- Comorbidity that excludes surgery (patients can still be entered into radiotherapy
randomization arm)