Staging is a critical element in treatment planning and should be clearly documented in the patient’s medical record.

Staging for prostate cancer involves these tests:

• DRE assessment to evaluate T-stage
• a CT abdomen-pelvis and bone scan (this is the conventional staging) – PSMA-PET/CT has been shown to have greater accuracy than conventional imaging for high-risk prostate cancers for assessing nodal or distant metastatic disease and can be performed as an alternative if available (Hofman et al. 2020).

Staging should not be undertaken for men with a PSA < 10 ng/mL and a Gleason score < 7, unless otherwise clinically indicated (Parker et al. 2015).

Determine the provisional treatment intent (curative or non-curative) before decisions on imaging are made (NICE 2019). Do not routinely recommend imaging for asymptomatic patients who are not candidates for curative treatment (NICE 2019).

Appropriate bone imaging is recommended when hormonal therapy is being deferred through watchful waiting of asymptomatic men (with incurable disease) who are at high risk of developing bone complications (NICE 2019). Interval reimaging may have a role in determining the appropriate timing of androgen deprivation therapy (ADT).

Pathological staging occurs after surgery, and synoptic reporting is encouraged.

Visit the Cancer Institute New South Wales website for information about understanding the stages of cancer.