Treatment for cure is reserved for patients with organ-confined prostate cancer. The clinical staging of prostate cancer lacks accuracy regarding local extension. The results of a transrectal ultrasound-guided staging biopsy (TGSB), performed in addition to routine sextant biopsies (RSBs) of the prostate, is defined as being positive when tumor cells are shown to invade extraprostatic loci and, thus, would certainly differentiate between organ-confined and locally advanced disease. Seventy-seven RSB + TGSB procedures were compared to 223 routine sextant prostate TRGBs. Prostate cancer (CaP) was detected in 24 patients (31%) and 60 patients (27%), respectively. In four RSB + TGSB procedures, local extension of CaP was depicted, and as a result radical prostatectomy was withheld. In six of seven patients undergoing radical prostatectomy (86%), the specimen analysis result was in agreement with the results of the preoperative TGSB. There were no extra complications associated with the performance of staging biopsies. We conclude that TGSB is safe and efficacious and that it should be performed in candidates for radical prostatectomy.