T3 prostate cancer: how reliable is clinical staging?

The treatment of locally advanced stage T3 prostate carcinoma remains controversial. The reliability of the clinical assessment of extracapsular extension by digital rectal examination (DRE) is therefore crucial. Results from series of patients with T3 prostate cancer treated by radical prostatectomy indicate that DRE has shown a wide range of accuracy from 44% to 82%. The assessment of capsule perforation on biopsy provides a 96% specificity rate and a positive predictive value of 60%. Furthermore, if the apparent clinical status of the seminal vesicle is incorrect, sampling errors on biopsy may be substantial. Biopsy therefore appears to provide a more accurate assessment of the capsule than of the seminal vesicle. Information regarding the correlation between T3 clinical staging and conventional/endorectal coil magnetic resonance imaging staging is still needed. Finally, the accuracy rate of DRE for T3 staging increases to more than 90% if the prostate-specific antigen level is greater than 15 ng/mL.