Hypofractionated Radiation Therapy or Conventional Radiation Therapy After Surgery in Treating Patients With Prostate Cancer

Inclusion Criteria

• PRIOR TO STEP 1 REGISTRATION
• Adenocarcinoma of the prostate treated primarily with radical prostatectomy
• Any type of radical prostatectomy will be permitted, including retropubic, perineal, laparoscopic, or robotically assisted; there is no time limit for the date of radical prostatectomy
• One of the following pathologic T-classifications: pT2 or pT3
• Patients with positive surgical margins are eligible
• One of the following pathologic N-classifications: pN0, pNX
• If a lymph node dissection is performed, the number of lymph nodes removed per side of the pelvis and the extent of the pelvic lymph node dissection (obturator versus [vs.] extended lymph node dissection) should be noted whenever possible
• No clinical evidence of regional lymph node metastasis
• Computed tomography (CT) (with contrast if renal function is acceptable; a noncontrast CT is permitted if the patient is not a candidate for contrast), magnetic resonance imaging (MRI), nodal sampling, or dissection of the pelvis within 120 days prior to step 1 registration
• Patients with pelvic lymph nodes equivocal or questionable by imaging are eligible if the nodes are = = 45 days after prostatectomy and within 30 days prior to step 1, = 0.2 ng/mL AND Gleason >= 7 (Considered for NRG-GU002, principal investigator [PI]: Hurwitz)
• pT2 with a negative surgical margin and PSA 6 months (180 days) duration;
• Note: The use of finasteride or dutasteride (+/- tamsulosin) for longer periods prior to prostatectomy is acceptable
• Androgen deprivation therapy started after prostatectomy and prior to step 1 registration for > 6 weeks (42 days)
• Neoadjuvant chemotherapy before or after prostatectomy
• Prior invasive (except non-melanoma skin cancer) malignancy unless disease-free for a minimum of 3 years and not in the pelvis; (for example, carcinoma in situ of the oral cavity is permissible if disease free for a minimum of 3 years; however, patients with prior history of bladder cancer are not allowed no matter the disease free duration); prior hematological (e.g., leukemia, lymphoma, myeloma) malignancy is not allowed
• Previous chemotherapy for any other disease site if given within 3 years prior to step 1
• Prior radiotherapy, including brachytherapy, to the region of the study cancer that would result in overlap of radiation therapy treatment volumes
• Severe, active co-morbidity, defined as follows:
• Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
• Transmural myocardial infarction within the last 6 months
• Acute bacterial or fungal infection requiring intravenous antibiotics at the time of step 1 registration
• Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of step 1 registration
• Severe hepatic disease, defined as a diagnosis of Child-Pugh class B or C hepatic disease
• Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD)4 count = 200 cells/microliter within 30 days prior to registration; note also that HIV testing is not required for eligibility for this protocol
• End-stage renal disease (ie, on dialysis or dialysis has been recommended)
• Prior allergic reaction to the study drugs involved in this protocol
• History of inflammatory bowel disease, prior bowel surgeries (or colostomy) for any reason, or prior partial/radical cystectomy for any reason