Diagnosis and staging of prostatic carcinoma: what is really necessary?

Diagnosis and staging of prostatic carcinoma should be considered in men in whom treatment with curative intent is possible. The primary tools for detection of cancer are digital rectal examination (DRE) and serum prostate-specific antigen (PSA), whereas transrectal ultrasonography is best used to guide the needle for biopsy. Staging should be based on the TNM system. The most reliable staging methods include a combination of DRE, PSA and systematic biopsies for local tumor extension, pelvic lymphadenectomy for regional lymph nodes, and PSA and bone scintigraphy for distant metastases. Computed tomography and magnetic resonance imaging are not necessary in most cases.