Prostate cancer (PCa) is the most common malignancy in men. The worsening of cellular undifferentiation, i.e., Gleason score (‘upgrade’) and clinical staging (‘upstage’) when comparing pre- and postoperative histopathological findings is well described in the literature. The objective of this study was to evaluate the histopathological results of prostate biopsies by transrectal ultrasound and surgical specimens from radical prostatectomy, from October 2022 to July 2024, at the Urology service of the General Hospital of Fortaleza. Preoperative factors such as serum PSA, transrectal ultrasound biopsy, and digital rectal examination were evaluated. Furthermore, histopathological parameters of the specimen were assessed, and it was observed that extraprostatic extension and focally affected margins were related to ‘upstage’. These data are insufficient to predict these conditions; therefore, new tools are needed to ensure better counseling for optimal treatment planning.