Optimal cost-effective staging evaluations in prostate cancer

A new diagnosis of prostate cancer presents to both the patient and physician questions regarding the best approach for further assessing the extent of disease prior to selecting a treatment strategy. In addition to the initial clinical data such as serum prostate-specific antigen level, findings on digital rectal examination, and core biopsy Gleason score, several procedures and imaging modalities are available to further stage newly diagnosed prostate cancer. A substantial percentage of the cost of managing prostate cancer is directly related to staging evaluations. Often, staging evaluations are performed that have limited test performance characteristics, subject the patient to unnecessary morbidity, or simply do not provide additional useful clinical information. It is important that the physician be familiar with the indications for the available staging modalities as well as the test performance characteristics in order to proceed appropriately and in an economically judicious fashion. This paper reviews the literature on this topic and summarizes previous experiences with procedures and imaging modalities for staging newly diagnosed prostate cancer.