Staging investigations include (but may not be limited to) the following:
- History, physical examination, including DRE
- CBC, BUN, creatinine, ALP, liver function tests, PSA (prior to DRE), urinalysis
- Biopsies of the prostate, with TRUS if available
- CXR (optional)
- Bone scan for patients with any of the following: PSA greater than or equal to 20; stage T3 or greater; Gleason score 8-10; or unexplained bony symptoms or signs (3). The use of bone scans in patients not meeting these criteria will be individualized.
- Pelvic lymph node staging in selected patients, e.g. those with an estimated risk of involvement of at least 15% (includes PSA greater than or equal to 20, or Gleason score 8-10, or T3-4, or PSA more than 10 but not more than 20 and Gleason score of 7) (6) . This may be done with laparoscopic lymph node sampling or CT, although the latter is less sensitive. Patients treated with radical prostatectomy usually have a pelvic lymph node sampling at the time of surgery except in low risk group where it is not necessary.