Determining Local-Regional Extension of Prostate Cancer

Prostate cancer evaluation and staging are based on the findings of clinical, radiological, and pathological studies. There has been a significant change in the type and availability of evaluative procedures in recent years. To summarize the current status of staging procedures, the role of computed tomography (CT), magnetic resonance imaging (MR), transrectal ultrasound (TRUS), lymph node dissection, and lymphangiogram in determining the extent of local and regional prostate cancer will be reviewed. CT has little utility in the assessment of local extension and is hampered in evaluating lymphatic metastasis because of a low sensitivity. However, CT is useful for radiotherapeutic treatment planning MR may provide better local disease assessment than TRUS, but TRUS is conducive to directed biospy of abnormalities. The role of laparoscopic lymph node dissection is expanding and early data seems to indicate that the procedure is similar to the more traditional procedure regarding the extent of anatomic dissection and number of lymph nodes removed for pathological examination. Stage migration occurs as staging procedures evolve and the proper role of staging procedures for prostate cancer must be considered to be a dynamic process, continually open for discussion and re-evaluation.