1. A decision is made as to whether to consider the patient for hormonal therapy prior to radiation (see this section.) or would be better treated with seeds or a combination of external beam plus seeds (see seed section.)
2.A decision is made as to whether to include nodes or seminal vesicles (see Partin Tables.)
3. The most common protocol calls for 3D conformal (5 or 6 field technique) 15mm margins (sometimes including seminal vesicles) that is carried to 5040 or 5580cGy) then the boost field generally does not include the seminal vesicles and uses tighter margins (15mm on all sides except the posterior/rectal side where margins are 12mm and superior/inferior margins are 20 mm) this field is carried to 7200-7560cGy and we generally treat to the 95% ISD.(at Sloan-Kettering the margins are 15mm around (11mm on rectal side) and 20mm sup/infer. as described IJROBP 2000;47:103, the RTOG protocols call for only a 5 - 10 mm margin. IMRT techniques are used in some patients depending on their anatomy and we generally use a 7 field technique and treat to 75 - 78Gy. As image guided IMRT has become available. particulalry with Tomotherapy it is now possible to safely increase the dose in high risk patients
4. There is no clear rule on how high a dose is safe for the rectum or bladder and the use of DVH (dose volume histograms) is under study;  a  reasonable guide would be the limits used below from RTOG P-0126