100 Background: Determine the feasibility of proton therapy for prostate cancer patients who have undergone unilateral hip replacement. Methods: From January, 2007 to March, 2008 5 patients with localized (4) or locally recurrent (1) prostate cancer and previous unilateral hip replacement underwent hip avoiding proton therapy. The median target dose was 78 Cobalt Gray Equivalent (Range 74CGE to 82CGE). All patients were treated in the supine position without a rectal balloon. Median maximum (1cc) dose to the normal femoral head was 51.47CGE (Range 43.82CGE to 64.50CGE). All patients signed informed consent and were registered to either the IRB approved UFPTI PR01, PR02 or Outcome Tracking (OTP) Protocols. Results: With a median follow up of 28 (range 15 to 39) months, no patient experienced grade 2 or higher late rectal toxicity. No patient experienced grade 3 or higher late urinary toxicity. Two patients experienced grade 2 urinary toxicity by virtue of having been placed on medication (tamsulosin) for urinary obstructive symptoms. No patient has reported hip fracture, hip pain or other skeletal event in the normal hip. Conclusions: Our experience suggests that patients with unilateral hip replacements can be treated with hip avoiding proton therapy without an increased risk of urinary, rectal or skeletal complications. No significant financial relationships to disclose.