Recent changes in the practice of medicine have compelled physicians not only to provide high-quality care but also to provide quality care in a cost-effective manner. In few areas of medicine is this task more controversial than in the care of patients with prostate cancer. Physicians, economists, and patients struggle with issues regarding screening, staging, treating, and palliating this increasingly prevalent disease.

Presenting serum prostate-specific antigen (PSA) level, digital rectal examination (DRE), and Gleason score on biopsy have been shown to predict the likelihood of metastatic disease in patients with newly diagnosed adenocarcinoma of the prostate. Several authors have suggested that CT scans, MR imaging scans, pedal lymphangiography, and pelvic lymph-node dissection can be eliminated safely in the initial staging evaluation of many patients with prostate cancer. The purpose of this article is to review the literature on this subject.