Salvage Brachytherapy and Interstitial Hyperthermia for Locally Recurrent Prostate Carcinoma Following Radiation Therapy

Inclusion Criteria:

* Histologically-confirmed locally recurrent prostate cancer - biopsy performed \< 6 months before registration;
* Histology: Adenocarcinoma, every Gleason score (2-10)
* Initial treatment (EBRT) completed \> 24 months prior to biopsy;
* Androgen deprivation therapy for prostate cancer should be discontinued at least 3 months prior to patient registration
* Staging performed within 12 weeks prior to registration:

  * Local stage evaluated by DRE, TRUS or - if necessary - mpMRI (T1b, T1c, T2a, T2b, T2c, T3a, T3b);
  * Negative lymph nodes by imaging studies (at least one of these: choline PET scan, pelvic ± abdominal CT or MRI) or by lymphadenectomy (cN0 or pN0);
  * Negative bone scan (M0);
* PSA-DT \> 6 months (PSA measurements taken of the 12 months prior to registration)
* Zubrod Performance Scale 0-2 (Appendix V) International Prostate Symptoms Score (IPSS) \< 20 (Appendix VI), the IPSS score can be evaluated in patient on alpha-blockers;
* Baseline gastrointestinal (GI) or genitourinary (GU) toxicity grade 0-1 as defined in Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

In TRUS volume study performed 0-4 weeks before registration patient meets eligibility criteria for prostate brachytherapy as follows:

* Prostate/tumor volume \<60ml
* The distance rear prostate edge - rectal mucosa \>5mm
* Interference of pubic arch ruled out
* If local stage T3b: it must be possible to cover by the brachytherapy dose cancer infiltration

  * Prostate lenght (from apex plane to base plane) ≤ 45mm (technical criterion for 915 MHz frequency antennas)
  * The patient is suitable for spinal or general anesthesia
  * Age \> 18 y.
  * Life expectancy \> 5 years
  * absence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
  * The patient must sign a study-specific informed consent form before study registration

Exclusion Criteria:

* Severe, active comorbidities:

  * Decompensated congestive heart disease
  * Chronic obstructive pulmonary disease exacerbation, respiratory failure
  * Hepatic insufficiency resulting in coagulation defects or clinical jaundice
* Other active malignancy or treatment of invasive or hematological malignancy
* Evidence of extraprostatic disease at local recurrence:

  * Local stage T4
  * Histologic or radiologic evidence of lymph node metastases (N1 or pN1)
  * Presence of distant metastases (M1)
* Any of the following prior therapies:

  * TURP within 6 months prior to registration
  * Prostatic salvage cryosurgery performed at least 6 months before registration
  * HIFU performed at least 6 months before registration
  * Androgen deprivation therapy within 3 months prior to registration
* Baseline gastrointestinal (GI) or genitourinary (GU) toxicity grade ≥ 2 as defined in Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.