PSMA PET Response Guided SabR in High Risk Pca

Inclusion Criteria:

-Pathologically confirmed adenocarcinoma of the prostate (within 180 days of registration) of high risk by national comprehensive cancer network (NCCN) criteria as determined by >=cT3a stage (AJCC 8th edition) OR PSA>20ng/mL OR ISUP Grade Group 4-5 (Gleason Grade 8-10).

Age ≥ 18 years.

• Planned for definitive intent stereotactic ablative radiotherapy (SabR) withintegrated dose boost to intra-prostatic tumor and androgen deprivation therapy (ADT) with baseline AUA IPSS <=18 and prostate size <=100cc

• Staging 68Ga PMSA-11 PET -CT or -MRI performed within 90 days of registration andbefore initiation of anti-androgen or androgen deprivation therapy and demonstratingno evidence of distant metastases by (PMSA avid or non-avid nodes <=1.5cm short axisallowed). Conventional imaging (CT, bone scan, MRI) may also be used in addition toPMSA-PET, and definitive findings of distant extra-pelvic metastases on these scansare not allowed for enrollment.

• Staging 68Ga PSMA-11 PET -CT or -MRI demonstrating a PSMA-avid primaryintra-prostatic target lesion amenable at investigator discretion to dose boost

• All men must agree to use adequate contraception (hormonal or barrier method ofbirth control; abstinence) prior to study entry, for the duration of standard ofcare SabR and for a period of time of 6 months thereafter as per standardguidelines. Should a man's partner become pregnant or suspect she is pregnant whileparticipating in this study, she should inform her treating physician immediately.

• Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

• Prior curative intent local therapy (e.g. prostatectomy, radiotherapy, focalablative therapy) for prostate cancer is not allowed, with following exceptionsregarding androgen deprivation therapy (ADT)/anti-androgen therapy (AAT):

Prior androgen deprivation therapy (ADT) allowed if <3 month total duration and stopped >=3 months prior to registration with demonstration of non-castrate testosterone recovery (>50ng/dL) and meeting all other inclusion criteria.

Ongoing androgen deprivation therapy (ADT) is allowed if <=60 days total duration AND meeting following criteria:

If GnRH agonist used (e.g. leuprolide), bicalutamide must have been used for at least 30 days +/-14 days from start of GnRH agonist.

All other inclusion criteria.

• Subjects may not be receiving any other investigational agents for the treatment ofthe cancer under study.

• History of allergic reactions to PMSA-11 68Ga imaging agent.

• Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection, symptomatic congestive heart failure, unstable angina pectoris, cardiacarrhythmia, or psychiatric illness/social situations that, in the opinion of theinvestigator, would limit compliance with study requirements.

• Prior pelvic radiotherapy other than cutaneous/superficial treatments.