Twice High Dose External Beam Radiotherapy by Image-guided Tomotherapy for Organ-confined Prostate Cancer Treatment Emulating High Dose Radiation (HDR) Brachytherapy

Inclusion Criteria:

* Histologically confirmed prostate adenocarcinoma (a diagnostic biopsy with at least 10 cores is needed)
* Low and intermediate-risk NCCN risk categories: low-risk ( cT1-2a, Gleason Score ≤ 6 PSA \<10 ng/ml) and among those with intermediate-risk features (clinical stage T2b-c or GS 7 or PSA 10-20 ng/ml) those patients with favorable ones (a single factor for intermediate risk and GLS 3 + 4 and \<50% of biopsy cores containing cancer) will be selected. (30).
* Age ≥18 years
* Good performance status , Eastern Cooperative Oncology Group (ECOG) \< 2) or Karnofsky performance status (KPS) \> 70
* No previous pelvic RT
* Patient not eligible to prostatectomy or patient's refusal to undergo surgery.
* NO previous prostatectomy or TURP
* Good urinary flow (peak flow ≥ 10 ml/s)
* Previous ADT is permitted
* Prostate size ≤ 60 cc
* International Prostate Symptom Score ≤ 15
* Male participants whose partner is of child bearing potential must be willing to ensure that they or their partner use effective contraception during the study and for 3 months thereafter
* Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

* Nodal involvement or distant metastases (cN1 or cM1)
* Extracapsular tumor or locally advanced disease (cT3-cT4)
* IPSS questionnaire \> 20
* Concomitant inflammatory bowel
* Prior history of chronic prostatitis
* Prior history of urethral stricture
* Important systemic diseases or oral anticoagulant therapy ongoing
* Non-conformity to dose constraints at the treatment planning
* Other invasive cancer (apart from non-melanoma skin), unless the patient has been free from disease for at least 3 years;
* Abnormal complete blood count. Any of the following: platelet count less than 75,000/ml, Hb level less than 10 gm/dl, WBC less than 3.5/ml, abnormal renal function tests (creatinine \> 1.5), severe renal impairment (GFR less than 30)
* Placement of pacemakers and metallic vascular clips (all contraindication to performing prostate mpMRI).