How many tests are indicated before proceeding with treatment is a controversial subject. To some extent, it depends on the individual’s risk for having cancer that has spread. For instance, if the patient has a low PSA, low Gleason grade and normal feeling prostate, some would argue that no further testing is indicated, including lymph node biopsy. On the other hand, if the PSA or Gleason grade are higher, further testing such as a bone scan and abdominal and pelvic CT or MRI scan might be indicated. Some of the tests currently available, such as Prostascint, ploidy, PAP, color endo-rectal MRI, complexed PSA, provide little additional useful information, in my opinion. I am usually comfortable if the patient has a bone scan with appropriate follow-up imaging studies of any abnormalities that might appear and an abdominal-pelvic CT scan.