OBJECTIVE To review the current published data on the role of color Doppler sonography and sonographically-guided staging biopsies in the detection and staging of prostate cancer. This article also discusses the role of color Doppler sonography in defining the ideal patients for neoadjuvant chemotherapy. METHODS Peer-reviewed reports in the radiologic, urologic, and medical literature were reviewed. Data from our own institution served as illustrative material. RESULTS Color Doppler sonography using state of the art ultrasound equipment produced from the mid 1990s onward can define areas of hypervascularity in the prostate. When located in the peripheral zone and associated with definable lesions, these areas likely represent carcinoma. More importantly, when isoechoic areas contain hypervascular foci with chaotic flow, cancer is also likely. In 93% of sites that contain normal vascularity, prostate cancer was not detected by biopsy. Staging biopsies are not frequently performed in current clinical practice. A positive seminal vesicle biopsy is associated with capsular penetration in 100% and positive lymph nodes in 50% of patients with prostate cancer. CONCLUSIONS Color Doppler sonography and staging biopsies may have a more significant role as newer alternative therapies for prostate cancer become popular. These two techniques show promise for increasing the accuracy of pretreatment staging over current algorithms, which are less than adequate.