Local staging of prostate cancer (PCa) aims at differentiating organ-confined disease from locally advanced disease (extracapsular extension (ECE) or seminal vesicle (SV) invasion (SVI)), which is important for risk assessment and treatment selection. Clinical staging using nomograms or formulas can calculate the percentage chance of extraprostatic extension (EPE) or distant metastases but lacks morphological information about the location, size, and shape of the disease. Preoperative magnetic resonance imaging (MRI) can fill this gap but suffers from inconsistent performance parameters, mainly due to technical and reading variations. This chapter describes a stepwise approach that follows a cancer growth timeline from purely intraprostatic to plainly extraprostatic. For peripheral zone cancers, early (microscopic) signs include tumor-capsular contact, capsular disruption, unsharp prostatic margin, and capsular bulging. Late (macroscopic) signs include irregular prostatic contour, periprostatic fat (PPF) infiltration, obliteration of the rectoprostatic angle (RPA), and the presence of a periprostatic mass. For cancers that perforate the anterior fibromuscular stroma, anterior bulging and tumor size are the most useful predictive signs. For seminal vesicle invasion, localized SV wall thickening, intraluminal mass (especially when combined with diffusion restriction or enhancement), and seminal vesicle destruction are consecutive signs of tumor progression.