The staging of prostate cancer

Abstract

The key role of staging in prostate cancer is to accurately determine the extent of the disease in order to place the man into a specific staging group and hence tailor the most appropriate treatments for each individual patient. Prostate cancer staging is at the present time a rapidly evolving field with many novel techniques in development. Initial clinical evaluation is performed by digital rectal examination combined with transrectal ultrasound. Traditionally, the evaluation of the primary tumor in terms of extracapsular extension and the regional/pelvic lymph nodes has been by body-array coil MRI cross-sectional imaging. Distant metastases are imaged by CT/MRI or radio nucleotide scanning corroborated by plain x-rays if required. A host of new imaging techniques are in evolution including modifications to standard MRI such as diffusion weighting and MR spectroscopy. These provide functional as well as anatomical information. MRI may even be of considerable use in the primary diagnosis of localized prostate cancer without or prior to biopsy in the near future. MRI can already show tumor volume, distribution, and possibly aggression. New technologies such as HistoScanning™ are being evaluated as useful predictors of disease volume, and trans-perineal template or saturation biopsies are increasingly used to stage disease volume and extent. Radiological imaging will play an increasingly important role in the staging of prostate cancer due to these emerging technological developments coupled with the development of new surgical and nonsurgical techniques in treating prostate cancer.