Surgical Staging of Carcinoma of the Prostate

Surgical staging (bilateral pelvic lymphadenectomy) has become a widely used and accepted procedure over the past eight years. It's utility is recognized by surgeons and radiotherapists alike. Approximately 15 to 20% of patients with small, palpable prostate cancer nodules (Stage B,) have (+) pelvic lymph nodes; over 30% of patients with larger but still intracapsular involvement (Stage B₂ ) have (+) nodes. Over 50% of patients with localized capsular penetration (Stage C) have (+) nodes. Poorly-differentiated tumors metastasize to nodes with greater frequency than do well-differentiated tumors. The complication rate appears to be acceptable with lymphocele formation, thromboembolic phenomena, wound infections, and lymphedema being some of the more common problems. Operative mortality due to pelvic lymphadenectomy is extremely rare. Multiple positive nodes are a bad prognostic sign, whereas one or two nodes with minimal tumor volume are much less ominous. Little data is available on the therapeutic efficacy of a thorough pelvic lymphadenectomy in combination with radical prostatectomy or radiotherapy in terms of 10 or 15 year survival. Such data should become available in the next few years.