Value of and indications for pelvic lymph node dissection in the staging of prostate cancer.

Pelvic lymphadenectomy is valuable as a staging procedure prior to radical prostatectomy in patients with clinical stages A2, B1 (except low-grade lesions), and B2 prostate cancer who seem to be good candidates for an attempt at curative surgery. Survival rates are promising in patients with negative pelvic lymph nodes and local tumors who undergo radical prostatectomy. In the presence of positive nodes, there is little reason to proceed with radical prostatectomy. Noninvasive alternatives to pelvic node dissection are appealing, but lymphangiography, ultrasound, computed tomography scanning, and magnetic resonance imaging are all less reliable than pelvic lymphadenectomy. Some morbidity is associated with surgical staging, and it is important that this be minimized. Pelvic lymph node dissection can play a role in treatment planning for patients who will be given external-beam radiation therapy. However, the role depends on the physician's treatment philosophy. In a recently reported series of patients receiving radiation therapy for localized prostate carcinoma, prior surgical staging by pelvic lymphadenectomy is uncommonly performed.