The Partin Table is useful because it allows men to picture the extent and severity of their prostate cancer. Although it does not give the "answer," it does list the possibilities. There are certain treatments that have their greatest effectiveness if the disease is confined to the prostate. These include surgery and implant therapy alone. Both of these treatment options have a very high cure rate if the disease is confined to the prostate. As the chance of the cancer extending beyond the prostate increases, these "prostate-only" treatments become less effective.

However, some men with disease beyond the prostate as in capsule penetration are still curable with implant therapy and surgery. Some people with capsular penetration have minimal and microscopic extension beyond the capsule, which is only detected under a microscope. This is still within the range of surgery and many people have been cured of prostate cancer when there is capsule penetration. The distinctions made in the Partin Table, therefore, cannot be reduced to literal black and white distinctions, since there is a wide range of severity within each category.

It is fair to conclude, however, that the success rate of a prostate-only treatment will be proportional to the percentage of prostate confinement and capsule penetration.

For men with a very high risk of cancer beyond the prostate, prostate plus margin options are available. These use external beam radiation therapy to create a margin of anticancer effect around the prostate. This is the great advantage of external beam therapy. For men with a high risk of disease beyond the prostate, many would advise a strategy that includes wide margin treatment. For some, external beam therapy can be given exclusively. For others, external beam therapy for five weeks might be combined with implant therapy to take advantage of both treatment options. The wide coverage is provided by the external beam radiation. The extremely high dose to the prostate, with the implant therapy where the bulk of the disease is, is also provided.

As mentioned, there is tremendous controversy about which men can be treated with implant therapy alone. As implant dosimetry and quality have improved, men with more advanced disease have been cured by implant therapy alone. In fact, some researchers attempting to compare results with all men who have received radiation treatment in one form or another have been unable to show that for men with a high risk of disease beyond the prostate, the addition of external beam therapy to implant therapy improved the cure rate.

This has left the researchers studying implant therapy with three distinct viewpoints. In one viewpoint, all men with prostate cancer confined to the pelvic area are candidates for implant therapy alone. In another point of view, due to vast research findings suggesting excellent efficacy, all men are treated with external beam therapy plus implant therapy. In the third approach, some men are considered excellent candidates for implant therapy alone while others with the probability of disease beyond the prostate are treated with external beam therapy combined with implant therapy.

At the University of Michigan and Providence Hospital, we have favored this latter approach where individuals treated with implant therapy alone are selected on the basis of a high chance of disease confined to the prostate. However, for younger men, a conservative approach is recommended. Many young men with low-risk disease are advised to consider external beam therapy in combination with implant therapy.

This latter recommendation stems from the fact that when prostate cancer is actually removed, some men have worse disease than anticipated by needle biopsy, PSA level, or stage. If treatment had been rendered based on their favorable characteristics, such men would be undertreated. Due to this uncertainty and the long-term follow-up likely in younger men, we have favored external beam therapy combined with implant therapy to cover all the possibilities. This is a conservative approach designed to adequately treat the disease known and the worst disease possible.