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Prostate cancer staging using imaging

The prostate continues to be the commonest site of male cancer; for example, there were 184 500 new cases in the USA in 1998, accounting for 29% of new cancer cases in American men [1]. It has been estimated that 39 200 men in the USA died from prostate cancer in 1998. These estimates make prostate cancer the second cause of cancer-related death in men [2,3] and the probability of developing prostate cancer from birth to death is 20% [3]. Treatment selection depends on patient age and health, cancer stage and grade, morbidity and mortality of treatment, together with the preference of the patient and the physician. The mainstay of treatment for organ-con®ned disease is either radical surgery or curative radiotherapy [4,5]. These are only considered to be options if there is no spread to the seminal vesicles (seminal vesicle invasion, SVI), extension through the prostatic capsule (extracapsular extension, ECE) or metastatic disease (TNM stage fT2N0M0). Therefore, the purpose of staging is to detect extraprostatic disease. Clinical staging by DRE and PSA level are relatively inaccurate, and imaging techniques such as TRUS and MRI can be used to increase the accuracy of staging. This review deals with the current possibilities and limitations of imaging in the staging of prostate cancer.